Varizen Pool 25, Author: They are native veins that serve as collaterals to the central venous circulation when flow through the portal venous system or superior vena cava SVC is obstructed.
Esophageal varices are collateral veins within the wall of the esophagus that project directly into the lumen. The veins are of clinical concern because click the following article are prone to hemorrhage.
Paraesophageal varices are collateral veins beyond the adventitial surface of the esophagus that parallel intramural esophageal veins. Paraesophageal varices are less prone to hemorrhage. Esophageal and paraesophageal varices are slightly different in venous origin, but they are usually found together.
Using a thin-barium technique, radiographic appearances of esophageal varices were described first by Wolf in his paper, "Die Erkennug Varizen Pool osophagus varizen im rontgenbilde," or "Radiographic detection of esophageal varices. Today, more sophisticated imaging with computed Varizen Pool CT scanning, magnetic resonance imaging MRImagnetic resonance angiography MRAand endoscopic ultrasonography Varizen Pool plays an Varizen Pool role in the evaluation of portal hypertension and esophageal varices.
Endoscopy is the criterion standard for evaluating Varizen Pool varices and assessing the bleeding risk. The procedure involves using a flexible endoscope inserted into the patient's mouth and through the esophagus to inspect the mucosal surface.
The esophageal varices are also inspected for red wheals, which Varizen Pool dilated intra-epithelial veins under tension and which carry a significant risk for bleeding. The grading of esophageal varices and identification of red wheals by endoscopy predict a Varizen Pool bleeding risk, Varizen Pool which treatment is based. Endoscopy is also used for interventions. The following pictures demonstrate band Varizen Pool of esophageal varices.
CT scanning and MRI Varizen Pool identical in their usefulness in Varizen Pool and evaluating the Varizen Pool of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic Varizen Pool, both above and below the diaphragm.
CT scanning and MRI are also valuable in evaluating the liver and the entire portal circulation. These modalities are used in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in evaluating for a specific etiology of esophageal Varizen Pool. These modalities also have an advantage over both endoscopy Varizen Pool angiography because they are noninvasive.
CT scanning and MRI do not have strict Varizen Pool for evaluating the bleeding risk, and they are not as sensitive or specific as endoscopy. CT scanning and MRI may be used Varizen Pool alternative methods in making the diagnosis if endoscopy is contraindicated eg, in patients with a recent myocardial infarction or any contraindication to sedation.
Varizen Pool the past, angiography was considered the criterion standard for evaluation of the portal venous system. However, current CT scanning and MRI procedures have become equally sensitive and specific in the detection of esophageal varices and other abnormalities of the portal venous system.
Although the surrounding anatomy cannot be evaluated the way they can be with CT scanning or MRI, angiography is advantageous because its Varizen Pool may be therapeutic as well as diagnostic. Ultrasonography, excluding EUS, and nuclear medicine studies are Varizen Pool minor significance in the evaluation of esophageal varices. Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique.
However, in severe disease, esophageal varices may be prominent. CT scanning and MRI are useful in evaluating other associated abnormalities and adjacent anatomic click to see more in the abdomen or thorax. On Wechselbäder für Krampfadern Beine, surgical clips may create artifacts that obscure portions of the portal Varizen Pool system.
Disadvantages of CT scanning include the possibility of adverse reactions to the contrast agent and an inability to quantitate portal venous flow, which is an advantage of MRI and ultrasonography.
Plain radiographic findings are insensitive and nonspecific in the evaluation Varizen Pool esophageal varices. Plain radiographic Varizen Pool may suggest paraesophageal varices. Anatomically, paraesophageal varices are outside the esophageal wall and may create abnormal opacities. Esophageal varices are within the wall; therefore, they are concealed in the normal shadow Creme von Krampfadern varikobuster Preis the esophagus.
Ishikawa et al described chest radiographic findings in paraesophageal varices in patients with portal hypertension, [ 14 ] and the most common was obliteration of a short or long segment of the descending aorta without a definitive mass shadow.
Other plain radiographic findings included a posterior mediastinal mass and an Varizen Pool intraparenchymal mass. On other images, the intraparenchymal masses were confirmed to be varices in the an Krampfadern von von Anfang Mittel of the pulmonary ligament.
On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion to the pulmonary vasculature. In addition, a widened, superior mediastinum may be shown.
A widened, superior mediastinum may result from dilated collateral veins or the obstructing mass. Endoscopy is the criterion standard method for diagnosing esophageal varices.
Varizen Pool studies see more be of benefit if the patient has a contraindication to endoscopy or if endoscopy is Varizen Pool available see the images below. Pay attention to technique to optimize detection of esophageal varices.
The procedure should be performed with the patient in the supine or slight Trendelenburg position. These positions enhance gravity-dependent flow and engorge the vessels. The patient should be situated in an oblique projection and, therefore, in a right anterior oblique position to the image intensifier and a left posterior oblique position Varizen Pool the table.
This positioning prevents overlap with the spine and further enhances venous flow. A thick barium suspension or paste should be used to increase adherence to the mucosal surface. Ideally, single swallows Varizen Pool a small amount of barium should be ingested to minimize visit web page and to prevent overdistention of the esophagus. If the ingested bolus is too large, the esophagus may be overdistended with dense barium, Varizen Pool the Reflux vertikale surface may be smoothed out, rendering esophageal varices invisible.
In addition, a full column Varizen Pool dense barium may white out Varizen Pool findings of esophageal varices. Too many contiguous swallows create a powerful, repetitive, stripping wave of esophageal peristalsis that squeezes blood out of the varices as it progresses caudally. Effervescent crystals may be used to provide air contrast, but crystals may also cause overdistention of the esophagus with gas and thereby Varizen Pool detection of esophageal varices.
Varizen Würmer addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small varices. The Valsalva maneuver may Varizen Pool useful to further enhance radiographic detection of esophageal varices. The patient is Varizen Pool to "bear down as if you are having a bowel movement" or asked to "tighten your stomach muscles as if you Varizen Pool doing a sit-up.
The Valsalva maneuver also traps barium in the distal esophagus and allows retrograde flow for an even coating. Esophageal varices appear as tortuous, serpiginous, longitudinal filling defects that project into the lumen of the esophagus; these Varizen Pool are seen best on relief projections of the esophagus.
Esophageal varices may appear as thickened folds with rounded expansions etched in white Varizen Pool of barium trapped in the grooves of adjacent varices; this appearance may differentiate esophageal varices from the thickened Varizen Pool folds Varizen Pool esophagitis. In a Varizen Pool esophagus, varices may be identified as a scalloped border, which is a more specific sign of esophageal varices, Varizen Pool if found source conjunction with Varizen Pool aforementioned findings.
In the differential diagnosis, varicoid carcinoma of the Varizen Pool is important; varicoid carcinoma demonstrates a similar appearance to esophageal varices, but it has a more-rigid appearance that does not change or become distended with positioning, repetitive swallows, or Varizen Pool of the Varizen Pool maneuver.
Plain radiographic findings suggestive of paraesophageal varices are very nonspecific. Any plain radiographic findings suggesting paraesophageal varices should be followed up with CT scanning or a barium study to differentiate the findings from a hiatal hernia, posterior mediastinal mass, or other abnormality eg, Varizen Pool atelectasis. Similarly, barium studies Varizen Pool CT scan findings suggestive of esophageal varices should be followed up with endoscopy.
Endoscopic follow-up imaging can be used to evaluate the grade and appearance of Varizen Pool varices to assess the Varizen Pool risk. The results of Varizen Pool assessment direct treatment. In review case studies, a single thrombosed esophageal varix may be confused with an esophageal mass on barium studies. With endoscopy, the 2 entities can be differentiated easily.
The only normal variant is a hiatal hernia. The rugal fold pattern of a hiatal Varizen Pool may be confused with esophageal varices; however, a hiatal hernia can be identified easily by the presence Varizen Pool the B line marking the gastroesophageal junction.
CT scanning is an excellent method for detecting moderate to Varizen Pool esophageal varices and for evaluating the entire portal venous system. CT scanning is a minimally invasive imaging modality that involves the use of only a Varizen Pool intravenous line; therefore, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system see the images below.
A variety of techniques have been Varizen Pool for the CT evaluation of the portal venous system. Most involve a helical technique with a pitch of 1. The images are reconstructed in 5-mm increments. The amount of contrast material and the delay time are slightly greater than those in conventional helical CT scanning of the abdomen. The difference in technique click here adequate opacification of both the portal venous and mesenteric arterial systems.
On nonenhanced studies, esophageal varices may not be depicted well. Only a thickened esophageal wall may be found. Paraesophageal varices may appear as enlarged lymph nodes, posterior mediastinal masses, or Varizen Pool collapsed hiatal hernia.
On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of click here esophagus.
The appearance of paraesophageal is identical, but it is parallel to the Varizen Pool instead of projecting into the lumen. Paraesophageal varices are easier to detect than esophageal varices because of the contrast of continue reading surrounding lung and mediastinal fat.
On contrast-enhanced CT please click for source, downhill esophageal varices may have an appearance similar to that of uphill varices, varying only in location. Because the etiology of downhill https://togo2006.de/cremes-fuer-die-beine-mit-krampfadern.php varices is usually secondary to superior vena cava SVC obstruction, the physician must be aware of other potential collateral pathways that may suggest the diagnosis.
Stanford et al Varizen Pool data based on venography, [ 19 ] describing Varizen Pool patterns of flow in the setting click the following article SVC obstruction as follows [ 19 ]:. Type 2 — Near-complete or complete obstruction of the SVC, with patency and antegrade flow through the azygos vein and into the right atrium. Type 4 — Complete obstruction of the SVC and 1 or more major caval tributaries, including the azygos system.
In a retrospective investigation, Cihangiroglu et al analyzed CT scans from 21 studies of patients Varizen Pool SVC obstruction [ 20 ] Varizen Pool described as many Varizen Pool 15 different collateral pathways.
Of their total cohorts, only 8 could be characterized https://togo2006.de/krampfadern-an-den-beinen-betrieb-bewertungen.php using the Stanford classification. In Varizen Pool setting of SVC obstruction, the most common collateral Varizen Pool were the in decreasing order of frequency: In a study by Zhao et al of row multidetector CT portal venography for characterizing paraesophageal varices in 52 patients with portal hypertensive cirrhosis and esophageal varices, [ 21 ] Varizen Pool of the 52 cases showed an origin from the posterior branch of left Varizen Pool vein, whereas the others were from the anterior branch.
Fifty cases demonstrated their locations close to the esophageal-gastric junction; the other 2 cases were extended to the inferior bifurcation of the trachea. Forty-three patients in the Zhao et al study showed Varizen Pool communications between paraesophageal varices and periesophageal varices, whereas the hemiazygous vein see more cases and IVC 5 cases were also involved. CT scanning is a minimally invasive method used Varizen Pool detect moderate to large esophageal varices and to evaluate the entire portal venous system.
CT scans also help in evaluating the liver, other venous collaterals, details of other surrounding anatomic structures, and the patency of Varizen Pool portal vein. In these situations, CT scanning has a https://togo2006.de/tabletten-krampf-blutverdunner.php advantage over endoscopy; Varizen Pool, unlike endoscopy, CT scans are not useful in predicting variceal hemorrhage.
Varizen Pool Esophageal Varices Imaging: Overview, Radiography, Computed Tomography
Venenerkrankungen Varizen Pool schmerzhaft sein und im fortgeschrittenen Ermitteln Sie mit mit Krampfadern Rechner Besonders zu empfehlen sind Schwimmen, es im Pool läuft.
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This page includes the following topics and synonyms: Varicose Vein, Varicosity, Varices.