Portal hipertansif gastropati ve gastrik varis görünümü BT bulguları

Özet

Siroz veya portal venöz akım bozukluğu olan hastada mide mukozasındaki konjesyon ve gastrik varisler BT'de portal hipertansiyonun eşlik eden bulguları olarak görülebilir. Portal faz kontrastlı BT, mide duvarı ve kıvrımların yanı sıra submukozal/perigastrik kollateralleri, besleyici venleri ve gastrorenal şantı haritalar. BT mukozal gastropati tanısını tek başına koydurmaz; portal hipertansif gastropatinin esas tanısı endoskopik görünümle konur. Varislerin kıvrımlı damarlar yerine kitle veya kalın mide kıvrımı sanılması kanama riskinin ve işlem öncesi damar anatomisinin yanlış değerlendirilmesine neden olabilir.

Faz ve pencere

Arteriyel: Dinamik karaciğer incelemesinde fundus veya korpus mukozasında geçici segmental/subsegmental hipoattenüasyon görülüp portal veya denge fazında normale dönebilir; bu işaret PHG ile ilişkilendirilmiştir, ancak PHG tanısı endoskopik görünümle konur ve BT bulgusu endoskopinin yerini tutmaz.
Portal tanısal: Portal ven ve mezenterik venlerle benzer yoğunlukta kontrastlanan, mide duvarı/submukozası içinde veya perigastrik alanda tübüler-serpijinöz venöz kanallar; splenik/sol gastrik ven bağlantısı, gastrorenal şant, splenomegali, asit ve karaciğer morfolojisi değerlendirilir.

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

BT bulguları

Fundus ve korpus kıvrımlarının kalın görünümü tek başına PHG tanısı koydurmaz; PHG, bu bölgelerdeki karakteristik endoskopik bulgularla tanınır.
Mide duvarı/submukozası içinde portal venle aynı düzeyde kontrastlanan kıvrımlı venöz kanallar
Mide fundusu çevresinde kısa gastrik ve posterior gastrik venlerden uzanan serpijinöz perigastrik kollateraller
Küçük kurvatur boyunca sol gastrik (koroner) ven ve gastroözofageal bileşkede kollateral damarlar
Fundal kollaterallerin sol renal vene açıldığı gastrorenal şant
Splenomegali, asit, portal ven kalibrasyon/değişiklikleri ve diğer portosistemik kollateraller

Ölçütler ve sınıflamalar

Sarin gastrik varis sınıflaması (endoskopik topografi): GOV1: özofagus varisinin küçük kurvatur boyunca uzantısı; GOV2: özofagogastrik bileşkedeki varisin fundus yönünde uzanımı. IGV1: fundusta izole varis; IGV2: fundus dışındaki mide bölgelerinde izole varis. Sınıflama endoskopik yerleşim tanımıdır; BT'de damarların topografisini tarif etmeye yardımcı olur.

Normalde

Normal midede fundus ve korpus kıvrımları düzenlidir; duvar içinde portal venle eş kontrastlanan serpijinöz submukozal damar ağı veya perigastrik kollateral kümesi görülmez. Kıyaslamada mukoza/kıvrım görünümünü, kısa gastrik ve sol gastrik venlerin seyrini, portal venöz fazda damarlarla eş zamanlı kontrastlanan kıvrımlı kanalların duvar içinde mi dışında mı olduğunu belirle.

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

Gastrik adenokarsinom: fokal düzensiz duvar kitlesi ve lümen deformasyonu; portal kanla eş yoğunlukta damar kanalları oluşturmaz
GIST: ekzofitik veya intramural solid kitle; damar gibi tübüler ve dallanan seyir göstermez
Gastrik rugae hipertrofisi: duvar kıvrımıyla devamlı yumuşak doku; portal fazda ayrı ayrı kontrastlanan lümenli kanallar değildir
Gastrit ve PHG: mukozal ödem ve diffüz hiperkontrastlanmaya yol açabilir; ancak varislerdeki gibi lümenli, portal ven yoğunluğunda düğümlenmiş veya serpijinöz kanal yapıları oluşturmaz.
Sol taraflı portal hipertansiyon, splenik ven trombozu gibi splanchnik venöz tıkanıklıklarla ilişkili olabilir; gastrik varisler portal hipertansiyonda görülebilir.

Tuzaklar

Gastrik varisler endoskopi veya baryum incelemesinde tümör ya da kalınlaşmış mide kıvrımlarını taklit edebilir; kontrastlı BT'de submukozal ve perigastrik kollateraller damar yapıları olarak görülebilir.
Gastrik varis ile perigastrik kollateral aynı yerde bulunabilir ama biri duvar içi, diğeri dış yüzeydedir; raporda anatomik kompartımanı tarif et.
Portal hipertansif gastropatinin mukozal görünümü endoskopik tanıdır; BT'de duvar ödemi veya arteriyel perfüzyon kusuru tek başına kesin PHG sayılmaz.
Fundal varisler siroz olmaksızın splenik ven darlığı veya tıkanıklığıyla ilişkili sol taraflı portal hipertansiyonda görülebilir; BT'de splenik ven ve portal sistem bulgularını karaciğer morfolojisiyle birlikte değerlendir.

Kendini dene

Sirozlu hastada fundus duvarında portal venle eş kontrastlanan serpijinöz yapılar ve sol renal vene devamlılık izleniyor. En olası nedir?
Cevabı göster
Gastrik varis ve gastrorenal şant. Portal venle eş kontrastlanan kıvrımlı submukozal damarlar ve renal vene devamlılık gastrik varis/gastrorenal şantı gösterir. Gastrik varisler BT'de tümörü veya kalınlaşmış rugae'yi taklit edebilir; portal ve mezenterik venlerle benzer kontrastlanan tübüler ya da serpijinöz damarlar varis lehine bulgudur.
GOV2 ve IGV1 gastrik varisleri genellikle hangi venlerden beslenir?
Cevabı göster
Kısa ve posterior gastrik venler. GOV2 ve IGV1 genellikle kısa ve posterior gastrik venlerden beslenir. GOV1 ise sol gastrik venin ön dalıyla ilişkilidir.

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-09).

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapypmc.ncbi.nlm.nih.gov
Spectrum of hepatofugal collateral pathways in portal hypertension: an illustrated radiological reviewpmc.ncbi.nlm.nih.gov
Video Capsule Endoscopy in the Assessment of Portal Hypertensive Enteropathypmc.ncbi.nlm.nih.gov
Splenic Artery Embolization, A Therapy that Can be Life-Saving for Small Bowel Variceal Bleedingpmc.ncbi.nlm.nih.gov
Successful Endoscopic Sealing of Gastric Perforation With Tissue Adhesive Following Endoscopic Treatment for Gastric Fundal Variceal Bleeding: A Case Reportpmc.ncbi.nlm.nih.gov
Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway.pubmed.ncbi.nlm.nih.gov
Major predictors of portal hypertensive enteropathy in patients with liver cirrhosis.pubmed.ncbi.nlm.nih.gov
Proximal spleno-renal shunt with retro-aortic left renal vein in a patient with extra-hepatic portal vein obstruction: first case report.pubmed.ncbi.nlm.nih.gov
Distal Duodenal Varices: First Presentation of Upper Gastrointestinal Bleeding.pubmed.ncbi.nlm.nih.gov
Clinical Analysis of Sinistral Portal Hypertension.pubmed.ncbi.nlm.nih.gov
Multifocal gastrointestinal varices: a rare manifestation of immunoglobulin G4-related disease.pubmed.ncbi.nlm.nih.gov
Large simple hepatic cysts leading to gastric fundal varices in a noncirrhotic patient.pubmed.ncbi.nlm.nih.gov
Splenic vein thrombosis in cirrhosis of the liver: A rare case.pubmed.ncbi.nlm.nih.gov
A case of obstructive jaundice caused by tuberculous lymphadenitis: a literature review.pubmed.ncbi.nlm.nih.gov
Sixty-four-slice computed tomography in surgical strategy of portal vein cavernous transformation.pubmed.ncbi.nlm.nih.gov
A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease.pubmed.ncbi.nlm.nih.gov
Small bowel capsule endoscopy and portal hypertensive enteropathy in cirrhotic patients: results from a tertiary referral centre.pubmed.ncbi.nlm.nih.gov
[A case of gastric adenocarcinoma presenting as portal hypertension].pubmed.ncbi.nlm.nih.gov
HYPOGENESIS OF RIGHT LOBE OF LIVER ACCOMPANIED BY PORTAL HYPERTENSION AND ESOPHAGOGASTRIC VARICEAL BLEEDING; A RARE ANOMALY: A CASE REPORT.pubmed.ncbi.nlm.nih.gov
Splenic Artery Embolization, A Therapy that Can be Life-Saving for Small Bowel Variceal Bleeding.pubmed.ncbi.nlm.nih.gov
Gastric Antral Vascular Ectasia as an Uncommon Cause of Upper Gastrointestinal Bleeding: A Case Report.pubmed.ncbi.nlm.nih.gov
Successful Endoscopic Sealing of Gastric Perforation With Tissue Adhesive Following Endoscopic Treatment for Gastric Fundal Variceal Bleeding: A Case Report.pubmed.ncbi.nlm.nih.gov
Use of a recanalized umbilical vein to embolize bleeding varices: A case report.pubmed.ncbi.nlm.nih.gov
Bleeding Stomal Varices and Vascular Interventional Radiology Management: 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
Septic Pylephlebitis and Cavernous Transformation Presenting as Pyrexia of Unknown Origin: A Diagnostic Challenge.pubmed.ncbi.nlm.nih.gov
Portal Hypertensive Gastrointestinal Disease in Liver Cirrhosis: The Diagnostic Value of Contrast-Enhanced Multi-Slice Spiral CT.pubmed.ncbi.nlm.nih.gov
JAK2-Positive Myeloproliferative Neoplasm: Polycythaemia Vera Presenting As Budd-Chiari Syndrome.pubmed.ncbi.nlm.nih.gov
Gastrointestinal bleeding: imaging and interventions in cancer patients.pubmed.ncbi.nlm.nih.gov
Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Gastric Varices: A Single-Center Experience in the Middle East.pubmed.ncbi.nlm.nih.gov
Clinical Implications and Management of Spontaneous Portosystemic Shunts in Liver Cirrhosis.pubmed.ncbi.nlm.nih.gov
A Misplaced Pocket of Air: Intramural Gastric Air Most Consistent With Gastric Emphysema.pubmed.ncbi.nlm.nih.gov
International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Nonproliferative and Proliferative Lesions of the Rabbit.pubmed.ncbi.nlm.nih.gov
Portal Hypertensive Enteropathy Presenting as Recurrent Large-Volume Urostomy Bleeding.pubmed.ncbi.nlm.nih.gov
An unusual superior mesenteric arteriovenous malformation causing obscure gastrointestinal bleeding: a case report.pubmed.ncbi.nlm.nih.gov
Chinese Guidelines for Clinical Diagnosis, Treatment, and Management of Cirrhosis (2025).pubmed.ncbi.nlm.nih.gov
Three Types of Collateral Arterial Supply to the Spleen After Spleen-Preserving Distal Pancreatectomies with Splenic Vessels Resection-How to Use This Knowledge for Organ(s) Preservation in Locally Advanced and Borderline Resectable Pancreatic Head Cancers Surgery-Hemodynamic, Surgical and Oncological Outcomes of 134 Spleen-Preserving Pancreatectomies.pubmed.ncbi.nlm.nih.gov
Safety and efficacy of minimally invasive splenectomy with endotherapy for non-cirrhotic portal fibrosis: A retrospective cohort study.pubmed.ncbi.nlm.nih.gov
Endoscopic ultrasound in portal hypertension: navigating venous hemodynamics and treatment efficacy.pubmed.ncbi.nlm.nih.gov
On the History of Hepatic Vein Catheterization.pubmed.ncbi.nlm.nih.gov
Understanding Portosystemic Collateral Anatomy.pubmed.ncbi.nlm.nih.gov
Pediatric Portal Hypertension Interventions: Ectopic Varices, Portal Vein Recanalization, Portosystemic Shunt Creation, and Maintenance of Surgical Shunts.pubmed.ncbi.nlm.nih.gov
Pathophysiological management of gastric varices: From hemodynamics to targeted therapies.pubmed.ncbi.nlm.nih.gov
Gastric varices: a contemporary review of vascular anatomy and therapeutic strategies.pubmed.ncbi.nlm.nih.gov
Umbilical vein recanalization with a diameter greater than 6.48mm may promote deterioration of liver reserve function: A retrospective cohort study.pubmed.ncbi.nlm.nih.gov
When a Bulbar Ulcer Hides a Darker Reality: The Unusual Diagnosis of a Portal Cavernoma in a 69-Year-Old Adult.pubmed.ncbi.nlm.nih.gov
Gun-sight technique for recanalization of chronic noncirrhotic, nonmalignant extrahepatic portal vein obstruction.pubmed.ncbi.nlm.nih.gov
Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave.pubmed.ncbi.nlm.nih.gov
Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review.pubmed.ncbi.nlm.nih.gov
Utility of transesophageal echocardiography during orthotopic liver transplantation: A narrative review.pubmed.ncbi.nlm.nih.gov
Hereditary Cancer Syndromes in Familial Breast Cancer: Insights Into Proactive Gastric Cancer Surveillance.pubmed.ncbi.nlm.nih.gov
Aberrant pancreas adenocarcinoma in the stomach: A case report and literature review.pubmed.ncbi.nlm.nih.gov
Magnetic Resonance Imaging of Uterine Cervix: A Pictorial Essay.pubmed.ncbi.nlm.nih.gov
Endoscopic ultrasound-guided cyanoacrylate therapy for gastric variceal bleeding secondary to sinistral portal hypertension: a retrospective case series.pubmed.ncbi.nlm.nih.gov
Initial Clinical Experience with Shape Memory Polymer Plugs for Various Venous Embolization.pubmed.ncbi.nlm.nih.gov
Radiologic Interventions for Gastrointestinal Bleeding.pubmed.ncbi.nlm.nih.gov
Prospective Visual Inspection of the Ventrum of Tongue (VIVOT) Vasculature Predicts the Presence of Esophageal Varices.pubmed.ncbi.nlm.nih.gov
BRTO-assisted endoscopic cyanoacrylate injection as a potential therapy for intractable acute gastric variceal bleeding with large SPSS: a retrospective single-center case series study.pubmed.ncbi.nlm.nih.gov
Computed tomography imaging features aid in identifying cirrhotic patients with poor response to endoscopic therapy for gastroesophageal variceal hemorrhage.pubmed.ncbi.nlm.nih.gov
Esophagogastric Junction Outflow Obstruction: A Diagnosis in Evolution.pubmed.ncbi.nlm.nih.gov
All about portal vein: a pictorial display to anatomy, variants and physiopathology.pubmed.ncbi.nlm.nih.gov
Endovascular treatment of portal hypertension and recurrent digestive hemorrhage secondary to arterioportal fistula syndrome: late complication of penetrating abdominal trauma.pubmed.ncbi.nlm.nih.gov
Salvage robotic-assisted subtotal esophagectomy after chemoradiotherapy for unresectable locally advanced esophageal sarcoma: A case report.pubmed.ncbi.nlm.nih.gov
Prediction of histopathological grade in gastric cancer using dual energy CT-derived synthetic extracellular volume fraction.pubmed.ncbi.nlm.nih.gov
Role of Endoscopic Ultrasonography in Management of Pancreaticobiliary Cancers: Recent Trends and Advances.pubmed.ncbi.nlm.nih.gov
Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract.pubmed.ncbi.nlm.nih.gov
Imaging of Gastrointestinal Tract Ailments.pubmed.ncbi.nlm.nih.gov
Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract?pubmed.ncbi.nlm.nih.gov
Case report: phlegmonous gastritis after endoscopic mucosal resection for a Helicobacter pylori-naïve foveolar-type gastric adenoma with a raspberry-like appearance.pubmed.ncbi.nlm.nih.gov
Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data.pubmed.ncbi.nlm.nih.gov
Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations.pubmed.ncbi.nlm.nih.gov
Idiopathic splenic vein stenosis with splenic infarction: a case report of rare non-bleeding cause of left-sided portal hypertension.pubmed.ncbi.nlm.nih.gov
Left-Sided Portal Hypertension Induced by Splenic Arteriovenous Malformation: A Case Report.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
Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
Noninvasive imaging assessment of portal hypertension.pubmed.ncbi.nlm.nih.gov
Acute heart failure after Orthotopic liver transplantation: a case series from one center.pubmed.ncbi.nlm.nih.gov
Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy.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
Plexiform fibromyxoma of the lesser curvature of the stomach in a 16-year-old adolescent: A case report and literature review.pubmed.ncbi.nlm.nih.gov
Photon-counting detector CT with iodine quantification: improved distinction between bland and neoplastic portal vein thrombosis.pubmed.ncbi.nlm.nih.gov
Preoperative transcatheter arterial embolization enables safe resection of a giant hypervascular pancreatic acinar cell carcinoma: A case report.pubmed.ncbi.nlm.nih.gov
Liver Point-of-Care Ultrasound (POCUS): Roadmap for training, credentialing, and implementation.pubmed.ncbi.nlm.nih.gov
Congenital hepatic fibrosis and related ciliopathies across the life course: current management, disease burden, and unmet needs in the era of genomic diagnosis and translational therapeutics.pubmed.ncbi.nlm.nih.gov
Management of Extrahepatic Portal Vein Obstruction With Spleno-Adrenal Shunt.pubmed.ncbi.nlm.nih.gov
Splenic infarction after endoscopic glue injection for gastric varices: proportion, exploratory correlates, and clinical outcomes from a propensity score-matched analysis.pubmed.ncbi.nlm.nih.gov
Two Cases of Gastric Varices with Left-sided Portal Hypertension Due to Essential Thrombocythemia Treated with Gastric Devascularization or Partial Splenic Embolization.pubmed.ncbi.nlm.nih.gov
Isolated Gastric Variceal Bleeding: A Sentinel Sign of Pancreatic Neoplasm Manifesting as Sinistral Portal Hypertension.pubmed.ncbi.nlm.nih.gov
Abernethy syndrome in Slovenian children: Five case reports and review of literature.pubmed.ncbi.nlm.nih.gov
When Portal Hypertension Conceals a Gastric Neuroendocrine Tumor: A Rare Mimic of Decompensated Chronic Liver Disease.pubmed.ncbi.nlm.nih.gov
Left inferior phrenic arterial malformation mimicking gastric varices: A case report and review of literature.pubmed.ncbi.nlm.nih.gov
Mucosa-Associated Lymphoid Tissue Lymphoma Masked as Gastric Varices With Acute Upper Gastrointestinal Bleeding: A Case Report.pubmed.ncbi.nlm.nih.gov
The Gastric Vein Variants: An Evidence-Based Systematic Review of Prevalence and Clinical Considerations.pubmed.ncbi.nlm.nih.gov
Mitochondrial dysfunction induced by HIF-1α under hypoxia contributes to the development of gastric mucosal lesions.pubmed.ncbi.nlm.nih.gov
Endohepatology in clinical practice: EUS-guided cyanoacrylate embolisation of gastroesophageal varices supplied by the gastric coronary vein.pubmed.ncbi.nlm.nih.gov
Pediatric non-cirrhotic portal hypertension: Endoscopic outcome and perspectives from developing nations.pubmed.ncbi.nlm.nih.gov
Combined endoscopic ultrasound and conventional endoscopy improves outcomes in bleeding GOV2 and IGV1 gastric varices: A multicenter retrospective propensity-matched cohort study.pubmed.ncbi.nlm.nih.gov
BRTO: Past, Present, and Future Directions.pubmed.ncbi.nlm.nih.gov
Long-Term Outcomes After Endoscopic Sequential Therapy in Patients With Gastroesophageal Variceal Bleeding as the First Decompensated Event.pubmed.ncbi.nlm.nih.gov
Chronic portal hypertension following inotuzumab ozogamicin in a low-risk patient: a case of overriding baseline risk and long-term management.pubmed.ncbi.nlm.nih.gov
Stent fracture after transjugular intrahepatic portosystemic shunt: A case report.pubmed.ncbi.nlm.nih.gov
An Atypical Vascular Complication: Splenic Vein Varix in a Pancreatic Pseudocyst.pubmed.ncbi.nlm.nih.gov
When Cancer Clots: An Extensive Radiologic Analysis of Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report.pubmed.ncbi.nlm.nih.gov
Exploring the neglected segment of the intestine: the duodenum and its pathologies.pubmed.ncbi.nlm.nih.gov
Long-term safety and effectiveness of the "OptEase" vena cava filter.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.