Splenic venous hypertension presenting as variceal hemorrhage caused by portal hypertension.
BACKGROUND
Splenic venous hypertension (SVH) may cause variceal hemorrhage that is clinically indistinguishable from similar bleeding caused by portal hypertension (PH). This may lead to erroneous treatment, including inappropriate portosystemic shunt placement.


METHODS
A retrospective review of 58 cases of variceal hemorrhage referred for transmesenteric variceal sclerotherapy and transvenous intrahepatic portosystemic shunt (TIPS) placement revealed that seven patients had SVH as a cause of bleeding, and required treatment other than TIPS. The role of medical imaging in the diagnosis and management of SVH was analyzed.


RESULTS
Clinical data did not permit a differential diagnosis between PH and SVH as the cause of bleeding in all cases. Splenic venous hypertension was suspected and then confirmed exclusively by contrast-enhanced computed tomography (CT) and angiography, which are essential for correct patient management.


CONCLUSIONS
Computed tomography should be routinely performed to exclude SVH before TIPS placement. In instances in which CT fails to establish the diagnosis or splenic artery occlusion is considered for patient management, angiography may be used.
Department of Radiology, Westchester County Medical Center, New York Medical College, Valhalla 10595, USA.
G
G
Rozenblit
L R
LR
Del Guercio
J
J
Savino
T
T
Cerabona
A
A
Policastro
M
M
McPhee
D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D012189:Retrospective Studies; D015911:Sclerotherapy; D013162:Splenic Vein