PMC9935947_01
Case 1. Isolated gastric varix bleeding caused by splenic vein obstruction. A 69-year-old male with hematemesis.. A. A venogram with a 5-Fr catheter at the proximal splenic vein shows the hepatopetal splenic and portal veins flow but fails to depict the afferent veins and gastric varices. The calcified lymph nodes are at the splenic hilum (arrow) (left image). A venogram with a 1.98-Fr microcatheter placed within the segmental splenic vein shows severe, short-segmental stenosis at the extreme proximal splenic vein from the 5-Fr catheter tip (which cannot pass the stenotic segment) (black arrow) to the contrast-filled venous lumen (white arrow) (middle image). Delayed phase image shows most of the splenic venous drainage divert to the gastric varix via the short gastric vein (right image).. B. Intraoperative cone-beam CT axial (left) and sagittal (right) images. A microcatheter is located between the calcified lymph nodes (arrows).. C. Contrast-enhanced CT sagittal image obtained 4 months preoperatively demonstrates splenic vein stenosis (arrow) between the calcified lymph nodes.. D. Fluoroscopic spot image during percutaneous transluminal angioplasty. The waist of a 6-mm x 40-mm balloon catheter (arrow) suggests short-segmental stenosis at the extreme proximal splenic vein.. E. CT axial images before (left) and after (right) the splenectomy.. F. Endoscopic images before (left) and after (right) the splenectomy. Gastric varices improved on the follow up images.
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F1
A splenic venogram with a catheter at the splenic vein demonstrated that the portal blood flow was hepatopetal (Fig. 1A; left). Aichi, Japan) was used, and finally, a 1.98-Fr microcatheter (Parkway soft, Asahi) was successfully placed within the segmental splenic vein. A splenic venogram showed a severe, short-segmented (1 cm) stenosis at the proximal splenic vein. And most of the splenic venous drainage was diverted to the gastric varix via the short gastric vein (Fig. 1A; middle, right). Cone-beam CT images (Fig. 1B) demonstrated that the stenosis was between the calcified lymph nodes, which were depicted on the patient's abdominal CT images (Fig. 1C). Scientific, Marlborough, MA, USA) had been placed, dilatation was performed with a 4-mm x 40-mm balloon catheter (Savvy long PTA catheter, Cordis, Fremont, CA, USA) and subsequently, with a 6-mm x 40-mm balloon catheter (Saber PTA dilatation catheter, Cordis) (Fig. 1D). Shortly after PTA, his blood pressure, and oxygen saturation started to decrease down to 50/26 mm Gastric varices improved on follow up CT and endoscopy (Fig. 1E, F).
PMC9935947_02
Case 2. Isolated gastric varx bleeding caused by splenic vein obstruction. A 57-year-old male with hematemesis and melena.. A. The axial arterial phase abdominal CT image reveals a pseudoaneurysm (arrow) arising from the splenic artery.. B, C. The axial and coronal portal venous phase images show fundal varices (arrowheads) and tortuously engorged gastroepiploic veins (arrows). Gross ductal dilatation and extensive calcifications are depicted in the pancreas. The pseudocyst encases splenic vessels, and the splenic vein is not visualized.. D. The arterial-phase image from the splenic angiogram reveals a pseudoaneurysm (arrow) with a wide neck from the splenic artery.. E. The delayed venous-phase image shows fundal varices opacification (arrowheads) without splenic venous enhancement.. F. Immediate post-embolization angiography demonstrates the complete splenic artery and pseudoaneurysm occlusion.
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F2
A major part of peripancreatic pseudocyst encases the splenic vessels, and concomitant splenic artery pseudoaneurysm (diameter: 1.9 cm) was also noted (Fig. 2).