TIPS’in BT görünümü BT bulguları

Özet

Transjuguler intrahepatik portosistemik şant (TIPS), portal ven ile hepatik venler arasında düşük dirençli bir kanal oluşturur. TIPS bulunan hastada kontrastlı BT, şantın anatomik güzergâhını, stent içi kontrast devamlılığını ve portal hipertansiyona eşlik eden karın bulgularını gösterir. BT anjiyografide açık TIPS içinde de kalıntı trombüs görülebilir; bu nedenle şantın açık görünmesi stent içi trombüsü dışlamaz.

Faz ve pencere

Portal tanısal: Portal venöz opaklaşma sırasında stent boyunca kontrastın sürekliliği ve portal ven ile hepatik ven/IVC bağlantısı izlenir; kontrastlanmayan intrastent dolum defekti trombüs veya stenoz kuşkusu doğurur, ancak metal artefaktı lümeni örtebilir.

Önerilen pencereler: Karaciğer (G 150 / M 30), Batın (G 400 / M 50), Anjiyo (G 600 / M 150).

BT bulguları

TIPS, portal ven ile hepatik venler arasında intrahepatik düşük dirençli bir kanal oluşturur.
Portal ven dalı ile hepatik venöz çıkış arasında izlenebilen kesintisiz stent gövdesi
BT anjiyografide TIPS içinde trombüs görülebilir.
BT anjiyografide, açık görünen TIPS içinde de stent içi kalıntı trombüs saptanabilir.
Metal stentin görülmesi trombüsü dışlamaz; BT anjiyografide TIPS içinde trombüs saptanabilir.
Splenomegali, kollateral damarlar, özofagogastrik varisler ve asit gibi portal hipertansiyon bulguları

Normalde

TIPS olmayan normal karaciğerde porta hepatis'ten çıkan portal dallar ile karaciğerden çıkan hepatik venler ayrı damar yataklarıdır; aralarında metalik, kesintisiz intrahepatik kanal bulunmaz. TIPS'li BT'de stent boyunca kontrast kolonu olup olmadığını, stentin hangi portal dalı hangi hepatik venöz çıkışa bağladığını ve çevre normal portal/hepatik venlerin kendi anatomik seyirlerini koruyup korumadığını kıyasla.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0541; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Portal ven trombozu: portal ven lümeninde trombüs izlenebilir ve splenik vene uzanabilir; TIPS içinde de eşlik eden trombüs bulunabilir.
Hepatik ven trombozu: çıkış damarında kontrastlanmayan lümen ve karaciğerde konjesyon görülür; TIPS metal gövdesi kendi içinde patent olabilir.
Cerrahi portosistemik şant: ekstrahepatik greft veya damar bağlantısı şeklindedir; karaciğer parankimi içinde portal daldan hepatik vene uzanan stent kanalı görünmez.
Portal venöz kollateraller: porta hepatis çevresinde kıvrımlı çoklu damarlar oluşturur; tek bir düzgün kalibreli metal stent gövdesi içermez.

Tuzaklar

Stent metalinin görülmesi açıklığı kanıtlamaz; BT anjiyografide stent içi trombüs ayrıca değerlendirilmelidir.
Portal venöz fazlı kesitsel görüntüleme, kollateral yolları ve portal-mezenterik trombozu değerlendirmeye yardımcı olur; TIPS ve portal venöz yapıları bu fazda gözden geçir.
TIPS güzergahının aşırı eğriliği veya inferior vena kavadan uzak olması şant disfonksiyonu riskini artırır; stent uçlarının damar içi konumu ve traktın merkeziliği değerlendirilmelidir.

Kendini dene

Siroz nedeniyle TIPS uygulanmış hastanın portal faz BT'sinde metal stent sağ portal daldan sağ hepatik vene uzanıyor ve lümen kontrastla doluyor. Bu görünüm neyi gösterir?
Cevabı göster
Patent görünümlü TIPS. Stentin portal dal ile hepatik venöz çıkış arasında uzanması ve portal fazda lümen boyunca kontrast görülmesi patent görünümlü şantı destekler. Anevrizma fokal venöz genişlemedir; Budd-Chiari hepatik venöz çıkış bozukluğudur; kavernöz transformasyon porta hepatis çevresindeki kollateral ağdır.
TIPS metal gövdesi seçiliyor ancak portal fazda şant lümeninin bir bölümü opaklaşmıyor. Bu bulgunun en doğru yorumu nedir?
Cevabı göster
Trombüs kuşkusu. Kontrastlanmayan intrastent segment trombüs kuşkusu doğurur; BT anjiyografide TIPS trombozu ve stent içinde artık trombüs görülebilir. Patent görünümlü bir TIPS'te bile stent içinde artık trombüs bulunabilir; BT anjiyografide stent içi trombüs değerlendirilmelidir.

İlgili konular

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-09).

Extracapsular tunneling for the management of delayed bilateral proximal corporal perforation: Case report and literature reviewpmc.ncbi.nlm.nih.gov
Glue Embolus-Induced Portosplenic Thrombosis in Transjugular Intrahepatic Portosystemic Shunt: A Novel Finding During Liver Transplantationpmc.ncbi.nlm.nih.gov
Narrative review of the current management of ectopic varices: an updatepmc.ncbi.nlm.nih.gov
Massive bleeding from a Bricker ileal conduit during FOLFIRINOX therapy in noncirrhotic portal hypertension: suspected oxaliplatin-associated sinusoidal injury and presumed irinotecan-associated conduit mucositis: a case reportpmc.ncbi.nlm.nih.gov
Bleeding Stomal Varices and Vascular Interventional Radiology Management: A Case Reportpmc.ncbi.nlm.nih.gov
Hepatic morphology abnormalities: beyond cirrhosis.pubmed.ncbi.nlm.nih.gov
Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement.pubmed.ncbi.nlm.nih.gov
Interventional Treatment of Acute Portal Vein Thrombosis.pubmed.ncbi.nlm.nih.gov
Technical pitfalls and tips for the valve-in-valve procedure.pubmed.ncbi.nlm.nih.gov
Bone condition of the maxillary zygomatic process prior to orthodontic anchorage plate fixation.pubmed.ncbi.nlm.nih.gov
Reno-portal shunt for liver transplant, an alternative inflow for recipients with grade III-IV portal vein thrombosis: Tips for a better outcome.pubmed.ncbi.nlm.nih.gov
[Perforation of carotid artery causing cervical hematoma].pubmed.ncbi.nlm.nih.gov
Pathophysiology of Primary Budd-Chiari Syndrome: A Narrative Review.pubmed.ncbi.nlm.nih.gov
Central Mandibular Reconstruction by Semiopen Wedge Osteotomy Double-barrel Fibula Flap for a Slim Aesthetic Appearance.pubmed.ncbi.nlm.nih.gov
Complete Ichthyornis skull illuminates mosaic assembly of the avian head.pubmed.ncbi.nlm.nih.gov
Diagnostic tips for parotid lymphoma.pubmed.ncbi.nlm.nih.gov
Selective growth of dual-color-emitting heterogeneous microdumbbells composed of organic charge-transfer complexes.pubmed.ncbi.nlm.nih.gov
Osseointegrated implants for orbito-facial prostheses: Preoperative planning tips and intraoperative pearls.pubmed.ncbi.nlm.nih.gov
The incidental bone lesion on computed tomography: management tips for abdominal radiologists.pubmed.ncbi.nlm.nih.gov
Management Strategies for Refractory Esophageal Varices.pubmed.ncbi.nlm.nih.gov
Endoscopic ultrasound in the management of complications related to cirrhosis- recent evidence.pubmed.ncbi.nlm.nih.gov
Portobiliary fistula after liver biopsy in a young transplant patient presenting with GI bleeding and hemorrhagic shock managed by embolization: a case report.pubmed.ncbi.nlm.nih.gov
Long-term outcome of percutaneous transhepatic venous embolization for ectopic peristomal variceal bleeding: A case report.pubmed.ncbi.nlm.nih.gov
Narrative review of the current management of ectopic varices: an update.pubmed.ncbi.nlm.nih.gov
Refractory Esophageal Varices Requiring Transjugular Intrahepatic Portosystemic Shunt Placement in Oxaliplatin-Induced Portosinusoidal Vascular Disorder.pubmed.ncbi.nlm.nih.gov
Sharp recanalization of extensive multilevel central venous occlusions in a young patient with familial Mediterranean fever: A case report.pubmed.ncbi.nlm.nih.gov
Clinical applications of 4D flow magnetic resonance imaging in hepatic vascular disorders: practical biomarkers, protocol design, and translational implementation.pubmed.ncbi.nlm.nih.gov
Case Report: Hemorrhagic-Thrombotic Escalation After Intraprocedural Rupture During Stent-Assisted Coiling: A Case-Based Narrative Review and Staged Communication Model.pubmed.ncbi.nlm.nih.gov
The role of multislice computerized tomography angiography in assessing postoperative vascular complications in liver transplant patientspubmed.ncbi.nlm.nih.gov
Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
High-affinity alphavbeta3 integrin targeted optical probe as a new imaging biomarker for early atherosclerosis: initial studies in Watanabe rabbits.pubmed.ncbi.nlm.nih.gov
When Cancer Clots: An Extensive Radiologic Analysis of Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
General principles and overview of vascular contrast-enhanced ultrasonography.pubmed.ncbi.nlm.nih.gov
Radiologic Interventions for Gastrointestinal Bleeding.pubmed.ncbi.nlm.nih.gov
Computed tomography of pediatric abdominal trauma: optimizing utilization and enhancing diagnostic interpretation.pubmed.ncbi.nlm.nih.gov
Portal vein embolization following arterial portography for the management of an active portal bleeding after blunt liver trauma in a cirrhotic patient.pubmed.ncbi.nlm.nih.gov
Portal vein recanalization and transjugular intrahepatic portosystemic shunt in chronic portal vein thrombosis: a narrative review.pubmed.ncbi.nlm.nih.gov
Endovascular closure of a large intrahepatic portosystemic shunt in a three-month-old infant: a case report and literature review.pubmed.ncbi.nlm.nih.gov
On the History of Hepatic Vein Catheterization.pubmed.ncbi.nlm.nih.gov
Comparison of specialized stent versus generic stent and bare stent combination for transjugular intrahepatic portosystemic shunt creation.pubmed.ncbi.nlm.nih.gov
Hepatic Vessel Map (HVM): An Expert-Annotated CT Dataset for Clinically Applicable AI in Liver Vascular Segmentation and Surgical Planning.pubmed.ncbi.nlm.nih.gov
Postnatal imaging of conjoined twins: a customized multimodality approach.pubmed.ncbi.nlm.nih.gov
Hepatic venous-portal gradient (HVPG) measurement: pearls and pitfalls.pubmed.ncbi.nlm.nih.gov
Engineering of Bioresorbable Polymers for Tissue Engineering and Drug Delivery Applications.pubmed.ncbi.nlm.nih.gov
Massive Esophagogastric Variceal Bleeding from Chronic Portal Vein Thrombosis in a Non-Cirrhotic Young Man: A Resource-Limited Endoscopic Management Dilemma.pubmed.ncbi.nlm.nih.gov
Management of parastomal variceal bleeding in an adult with metastatic liver cancer: A case-based review.pubmed.ncbi.nlm.nih.gov
Urostomy-associated stomal variceal hemorrhage secondary to portal hypertension: A case report and interventional radiology-guided management.pubmed.ncbi.nlm.nih.gov
Imaging and Intervention in the Management of Vascular Complications Following Liver Transplantation.pubmed.ncbi.nlm.nih.gov
Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
Balloon-Occluded Transarterial Chemoembolization for Hepatocellular Carcinoma: Technical Rationale, Current Evidence, and Future Directions.pubmed.ncbi.nlm.nih.gov
Multiparametric Abdominal Ultrasound as a Source of Imaging Biomarkers in Predictive and Personalized Medicine: A Narrative Review.pubmed.ncbi.nlm.nih.gov
Understanding Portosystemic Collateral Anatomy.pubmed.ncbi.nlm.nih.gov
Transabdominal Ultrasound-guided Transjugular Endovascular Mesocaval Shunt Creation in Extrahepatic Portal Vein Obstruction: A Single-center Experience.pubmed.ncbi.nlm.nih.gov
From congenital variants to critical clues: A radiologic review of inferior vena cava pathologies.pubmed.ncbi.nlm.nih.gov
Chronic abdominal pain secondary to portosystemic collateral vessels: A case report and review of etiologies.pubmed.ncbi.nlm.nih.gov
Unusual Etiology of Budd-Chiari Syndrome in an Adolescent: A Case of Combined Thrombophilic Disorder.pubmed.ncbi.nlm.nih.gov
Multiparametric Ultrasound in Budd-Chiari Syndrome: From Venous Outflow Obstruction to Microcirculatory Dysfunction.pubmed.ncbi.nlm.nih.gov
JAK2-Positive Myeloproliferative Neoplasm: Polycythaemia Vera Presenting As Budd-Chiari Syndrome.pubmed.ncbi.nlm.nih.gov
Managing High-Risk Liver Transplantation: A Case of Budd-Chiari Syndrome With Preemptive Venovenous Extracorporeal Membrane Oxygenation (ECMO).pubmed.ncbi.nlm.nih.gov
Case Report: Adult liver transplantation using a long-standing mesocaval shunt as portal inflow in congenital absence of the portal vein with atypical variceal bleeding and refractory shunt encephalopathy.pubmed.ncbi.nlm.nih.gov
Sarcopenia Predicts Mortality and Hepatic Encephalopathy After TIPS in Older Adults With Cirrhosis and Improves Prognostic Scores.pubmed.ncbi.nlm.nih.gov
Inflammatory Hilar Mass and Cavernous Transformation in Disseminated Histoplasmosis: A Rare Cause of Noncirrhotic Portal Hypertension.pubmed.ncbi.nlm.nih.gov
An unusual presentation of portal biliopathy manifesting as chronic abdominal pain as a delayed post-splenectomy complication: a case report.pubmed.ncbi.nlm.nih.gov
Special Issue: EACR 2026 Congress: Innovative Cancer Science, 8-11 June 2026.pubmed.ncbi.nlm.nih.gov
2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.pubmed.ncbi.nlm.nih.gov
Abernethy Malformation Type Ib in a Patient With Trisomy 21: A Rare Case of Portal Vein Absence, Mesenteric Thrombosis, and Bowel Perforation.pubmed.ncbi.nlm.nih.gov
Review of Artificial Intelligence for Automated Assessment of Lines, Drains, and Airways on Pediatric and Adult Chest Radiographs.pubmed.ncbi.nlm.nih.gov
North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension.pubmed.ncbi.nlm.nih.gov
Preoperative Imaging Assessment and Staging of Perihilar Cholangiocarcinoma: Tips and Pitfalls.pubmed.ncbi.nlm.nih.gov
The Role of Imaging in Portal Vein Thrombosis: From the Diagnosis to the Interventional Radiological Management.pubmed.ncbi.nlm.nih.gov
One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics.pubmed.ncbi.nlm.nih.gov
Personalized 3D surgical planning in liver transplantation: A new era in preoperative assessment and management of vascular and biliary complications.pubmed.ncbi.nlm.nih.gov
Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series.pubmed.ncbi.nlm.nih.gov
Rare Causes of Portal Vein Thrombosis and Occlusion: A Narrative Review.pubmed.ncbi.nlm.nih.gov
Use of Partial Splenic Embolization Following a Transjugular Intrahepatic Portosystemic Shunt to Reduce Persistent Portal Hypertension Sequelae.pubmed.ncbi.nlm.nih.gov
Multimodal imaging features to diagnose abdominal complications of sickle cell disease.pubmed.ncbi.nlm.nih.gov
Gun-sight technique for recanalization of chronic noncirrhotic, nonmalignant extrahepatic portal vein obstruction.pubmed.ncbi.nlm.nih.gov
Transjugular intrahepatic portosystemic shunt for hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloid.pubmed.ncbi.nlm.nih.gov
Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
Idiopathic Intracranial Hypertension Animal Models and Venous Sinus Stenting: Status of Disease and Device-Focused Evidence.pubmed.ncbi.nlm.nih.gov
Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes.pubmed.ncbi.nlm.nih.gov
International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
Hepatic Vascular Involvement in Adenosine Deaminase 2 Deficiency (DADA2): Case Reports and Literature Review.pubmed.ncbi.nlm.nih.gov
Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management.pubmed.ncbi.nlm.nih.gov
Does laparoscopic surgery decrease the risk of atrial fibrillation after foregut surgery?pubmed.ncbi.nlm.nih.gov
Three-Dimensional Transjugular Intrahepatic Portosystemic Shunt Geometry Predicts Shunt Dysfunction.pubmed.ncbi.nlm.nih.gov
Tips and tricks for the diagnosis and management of biliary stenosis-state of the art review.pubmed.ncbi.nlm.nih.gov
The Role of CT-Angiography in the Acute Gastrointestinal Bleeding: A Pictorial Essay of Active and Obscure Findings.pubmed.ncbi.nlm.nih.gov
<i>Cryptococcus gattii</i> CNS infection presenting as a periaqueductal "soap-bubble" lesion causing obstructive hydrocephalus with refractory CSF diversion.pubmed.ncbi.nlm.nih.gov
Bleeding Stomal Varices and Vascular Interventional Radiology Management: A Case Report.pubmed.ncbi.nlm.nih.gov
Stereotactic Microwave Ablation of Early-Stage Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts: A Matched Case-Control Study.pubmed.ncbi.nlm.nih.gov
Latest Advances in Multimodality Imaging of Aortic Stenosis.pubmed.ncbi.nlm.nih.gov
Liver Transplant Complications Radiologist Can't Miss.pubmed.ncbi.nlm.nih.gov
Imaging panorama in postoperative complications after liver transplantation.pubmed.ncbi.nlm.nih.gov
Imaging of inferior vena cava normal variants, anomalies and pathologies, Part 2: Acquired.pubmed.ncbi.nlm.nih.gov
The spectrum of computed tomography findings in blunt trauma of the subclavian/axillary artery: a pictorial essay.pubmed.ncbi.nlm.nih.gov
Pediatric Stroke Imaging.pubmed.ncbi.nlm.nih.gov
Deep learning in medical imaging and radiation therapy.pubmed.ncbi.nlm.nih.gov
EUS-guided esophagogastric variceal obliteration: real-world cohort of three generation glue embolization (with video).pubmed.ncbi.nlm.nih.gov
Portal vein reconstruction in iatrogenic portal vein ligation.pubmed.ncbi.nlm.nih.gov
Non-Thrombotic Filling Defects in Cerebral Veins and Sinuses: When Normal Structures Mimic a Disease.pubmed.ncbi.nlm.nih.gov
Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?pubmed.ncbi.nlm.nih.gov
Management of splanchnic vein thrombosis.pubmed.ncbi.nlm.nih.gov
Current State of Imaging of Pediatric Pancreatitis: AJR Expert Panel Narrative Review.pubmed.ncbi.nlm.nih.gov
A rare case of bleeding duodenal varices from superior mesenteric vein obstruction -treated with transhepatic recanalization and stent placement.pubmed.ncbi.nlm.nih.gov
Portal Hypertensive Enteropathy Presenting as Recurrent Large-Volume Urostomy Bleeding.pubmed.ncbi.nlm.nih.gov
Back From the Past: A Case of Transjugular Intrahepatic Shunt-Induced Hemolysis?pubmed.ncbi.nlm.nih.gov
Systemic Venous Recanalization: Iliocaval and Superior Vena Cava Reconstruction in Children.pubmed.ncbi.nlm.nih.gov
Portal Vein Thrombosis, Management and Approaches in Liver Transplantation: A Narrative Review.pubmed.ncbi.nlm.nih.gov
Glue Embolus-Induced Portosplenic Thrombosis in Transjugular Intrahepatic Portosystemic Shunt: A Novel Finding During Liver Transplantation.pubmed.ncbi.nlm.nih.gov
Interventional Radiology Options after Visceral Surgery.pubmed.ncbi.nlm.nih.gov
Transjugular Intrahepatic Portosystemic Shunt for Portal Vein Thrombosis in Cirrhotic Patients: 18-Year Experience in a Tertiary Referral Hospital.pubmed.ncbi.nlm.nih.gov
Triple Threat: SLE, APS, and Clotting Factor Abnormalities Leading to Subacute Budd-Chiari Syndrome. A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
Porto-sinusoidal Vascular Disease: Classification and Clinical Relevance.pubmed.ncbi.nlm.nih.gov
The Role of Interventional Radiology for the Treatment of Liver CE and AE Lesions: Current Concepts.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.