VARICES IN PORTAL-HYPERTENSION - EVALUATION WITH CT

The portosystemic collateral channels that can develop in portal hypertension are numerous, widespread, and varied in appearance. The reported prevalences of varices at each anatomic site vary according to the diagnostic modality used. Dynamic computed tomography (CT) performed with a bolus of contrast material demonstrates collateral vessels with exquisite detail. On CT scans? varices appear as well-defined round, tubular, or serpentine structures that are smooth, have homogeneous attenuation, and enhance with contrast material to the same degree as adjacent vessels. In 60 consecutive patients with varices and evidence of cirrhosis, the most common portosystemic collateral channels were coronary venous collateral vessels in the lesser omentum, seen in 80% of cases. Esophageal, paraumbilical, abdominal wall, perisplenic, retrogastric, paraesophageal, omental, retroperitoneal-paravertebral, and mesenteric varices were also found, along with spontaneous splenorenal and gastrorenal shunts. Knowledge of the CT appearance and the prevalence of varices at each anatomic site will improve diagnostic accuracy.