Cirrhosis and portal hypertension

The commonest cause of portal hypertension is cirrhosis secondary to alcoholic liver disease or chronic hepatitis B or C (see Fig. 6.24), further causes are listed in Table 6.3. Imaging features of cirrhosis and portal hypertension include liver nodularity, reversal of portal blood flow (demonstrated on ultrasound), porto-systemic colateral vessels, splenomegaly, ascites and complications such as hepatoma. Porto-systemic colateral vessels occur at many sites (see Table 6.4) as a consequence of portal hypertension (see Fig. 6.25).

Fig. 6.24 Liver cirrhosis complicated by hepatoma. The liver has an irregular, nodular outline which is typical of cirrhosis. Hepatomas, such as this example, have avid arterial enhancement.

Table 6.3 Causes of Portal Hypertension

Prehepatic

• Portal vein compression/thrombosis Hepatic

• Hepatic fibrosis congenital/acquired

• Cystic fibrosis

• Chronic malaria

• Schistosomiasis

Post-hepatic

• Budd-Chiari syndrome

• Constrictive pericarditis

Table 6.4 Sites of porto-systemic collaterals

■ Oesophageal

■ Coronary vein

■ Para-umbilical

■ Abdominal wall

■ Splenorenal

■ Mesenteric

■ Haemorrhoidal

Hepatocellular Adenoma Mri
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