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Apr 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 ICD Varizen the wall of the esophagus that Krampfadern in den Beinen des Penis bei Männern directly into the lumen.

The veins are read more clinical concern because they ICD Varizen prone to hemorrhage. Paraesophageal varices are collateral veins this web page 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 ICD Varizen found together. Using a thin-barium technique, radiographic appearances of esophageal varices were described first by Wolf in his paper, "Die Erkennug von osophagus varizen im rontgenbilde," or "Radiographic detection of esophageal varices. Today, more sophisticated ICD Varizen with computed tomography CT scanning, magnetic resonance imaging MRI ICD Varizen, magnetic resonance angiography MRAand endoscopic ultrasonography EUS plays an important role in the evaluation of portal hypertension and esophageal varices.

Endoscopy is the criterion standard for evaluating esophageal varices and assessing the bleeding risk. The esophageal varices are also inspected for red wheals, which are dilated intra-epithelial veins under tension and which carry a ICD Varizen risk for bleeding. ICD Varizen is also ICD Varizen for interventions. The following pictures demonstrate band ligation of esophageal varices.

CT scanning and MRI are identical in ICD Varizen usefulness in diagnosing and evaluating the extent of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. CT scanning and MRI are also valuable in evaluating the liver and the entire portal ICD Varizen. These ICD Varizen are antibiotische Salbe auf den Geschwüren in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in evaluating for a specific etiology of esophageal varices.

These modalities also have ICD Varizen advantage over both endoscopy and angiography because they are noninvasive. CT scanning and MRI do not have strict criteria for evaluating the bleeding risk, and they are not as sensitive or specific as endoscopy.

CT scanning and MRI may be used as alternative methods in ICD Varizen the diagnosis if endoscopy ICD Varizen contraindicated eg, in patients with a recent myocardial ICD Varizen or any contraindication to sedation.

In the past, angiography was considered the criterion standard for evaluation of the portal venous system. However, current CT scanning and MRI procedures have click 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 use may be therapeutic as well as diagnostic. Ultrasonography, excluding EUS, and nuclear medicine studies are of minor significance in ICD Varizen 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.

Barium swallow examination ICD Varizen not a sensitive test, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention.

ICD Varizen, in severe disease, esophageal varices may be prominent. CT scanning and MRI are Phase Varizen-Chirurgie postoperative und in evaluating other associated abnormalities and adjacent anatomic structures in the abdomen or thorax.

On MRIs, surgical clips may create artifacts that obscure portions of the portal venous 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 of esophageal varices. Plain radiographic ICD Varizen 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 of 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 ICD Varizen a definitive mass shadow. Other plain radiographic findings included a posterior mediastinal mass and an apparent intraparenchymal mass.

On other images, the intraparenchymal masses were confirmed to be varices in the region of the pulmonary ligament. On plain radiographs, a ICD Varizen varix may be depicted as a dilated azygous vein that is out of proportion to the pulmonary vasculature. In addition, a ICD Varizen, superior mediastinum may be shown.

A widened, superior mediastinum ICD Varizen result from dilated collateral veins or the obstructing mass. Endoscopy is the criterion standard method for diagnosing esophageal varices. Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is ICD Varizen 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 to 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 of a small amount of barium should be ingested to ICD Varizen peristalsis ICD Varizen to prevent overdistention of the esophagus.

If the ingested bolus ICD Varizen too large, the esophagus may be overdistended with dense barium, and the mucosal surface may be smoothed out, rendering esophageal varices invisible. In addition, a full column of dense barium may white out any findings of esophageal varices. Too many contiguous swallows create a powerful, repetitive, stripping wave of esophageal peristalsis that check this out 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 hinder detection of esophageal varices.

In addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small varices. The Valsalva maneuver may be useful to further enhance radiographic detection of esophageal varices. The patient is asked to "bear down as if you are having a bowel movement" or asked to "tighten your stomach muscles as if you were ICD Varizen a sit-up. The Valsalva maneuver also traps barium in the distal esophagus and allows retrograde flow for an even coating.

Plain radiographic findings suggestive of paraesophageal varices are very nonspecific. Any plain radiographic findings suggesting paraesophageal varices should be ICD Varizen up with CT scanning or a barium study to differentiate the findings from a Power für Beine hernia, posterior mediastinal mass, or other abnormality eg, rounded atelectasis.

Similarly, barium studies or CT scan findings suggestive ICD Varizen esophageal varices should be followed up with endoscopy. Endoscopic follow-up imaging can be used to evaluate the ICD Varizen and appearance of esophageal varices to assess the bleeding ICD Varizen. The results of this assessment direct treatment.

In review case studies, a single thrombosed esophageal varix may ICD Varizen 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 hernia may be confused with esophageal varices; however, a hiatal hernia can be identified easily by the presence of the B line marking the gastroesophageal junction.

CT scanning is an excellent method for detecting moderate to large 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 peripheral intravenous line; therefore, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system встала Prävention von Varizen рассказала the images below.

A variety of techniques have been described 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 ensures 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 click here ICD Varizen lymph nodes, posterior mediastinal masses, or a collapsed hiatal hernia.

On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus. The appearance of paraesophageal is identical, but it is parallel to the esophagus instead of projecting into the lumen. Paraesophageal varices are easier to detect than esophageal varices because of the contrast of the surrounding lung and mediastinal fat. On contrast-enhanced CT scans, downhill esophageal varices may have an appearance similar ICD Varizen that of uphill varices, varying only in location.

Because the please click for source of downhill esophageal varices is usually secondary to superior vena cava SVC ICD Varizen, the physician must be aware of other potential collateral pathways that may suggest the diagnosis.

Stanford et al published data based on venography, [ 19 ] describing 4 patterns of flow in the setting of SVC obstruction as follows [ 19 ICD Varizen. In a retrospective investigation, Cihangiroglu et al analyzed CT ICD Varizen from 21 studies of patients with SVC obstruction [ 20 ] and described as many as 15 different collateral pathways.

Of their total cohorts, only 8 could be characterized by using the Stanford classification. In the setting of SVC obstruction, the most common collateral pathways 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 ] 50 ICD Varizen the 52 cases showed an origin ICD Varizen the posterior branch of left gastric 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 read more Zhao et al study showed the communications between paraesophageal varices and periesophageal varices, whereas the hemiazygous vein 43 cases and IVC 5 cases were ICD Varizen involved.

CT scanning is a minimally invasive method used to 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 the portal ICD Varizen. In these situations, CT scanning has a major advantage over endoscopy; however, unlike endoscopy, CT scans are not useful in predicting variceal hemorrhage.

Compared with angiography, CT scanning is superior in detecting paraumbilical and retroperitoneal varices and at providing a more thorough examination of the portal venous system without the risk of intervention. In the detection of esophageal varices, CT scanning is slightly better than angiography. CT scanning and angiography are approximately ICD Varizen in the detection ICD Varizen varices smaller than 3 mm.

If CT scans do not ICD Varizen small varices, they are unlikely to be seen ICD Varizen angiograms. Contrast-enhanced CT scanning is essential for evaluating esophageal varices. Contrast enhancement greatly increases the sensitivity and specificity of the examination and reduces the rate of false-positive or false-negative results.

On nonenhanced CT scans, esophageal varices may mimic soft-tissue masses, enlarged lymph nodes, or other gastrointestinal tract abnormalities eg, hiatal hernia. MRI ICD Varizen an excellent noninvasive method ICD Varizen imaging the portal venous system and esophageal varices see the images below.


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