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Detecting Bleeding Duodenal Varices with Multislice Helical CT

Dominik Weishaupt1, Thomas Pfammatter, Paul R. Hilfiker, Ursula Wolfensberger and Borut Marincek

1 All authors: Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.



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  		Fig. 1A. —59-year-old woman with massive upper gastrointestinal bleeding. Axial contrast-enhanced CT scan shows varices (arrow) within posterior wall of second part of duodenum.

 


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  		Fig. 1B. —59-year-old woman with massive upper gastrointestinal bleeding. Maximum-intensity-projection CT image obtained in oblique sagittal plane reveals duodenal varices (long arrow) with efferent vessel draining through right gonadal vein and right renal vein (short arrow) to inferior vena cava (IVC). Afferent vessel originates in proximal branches of superior mesenteric vein (arrowhead).

 


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  		Fig. 1C. —59-year-old woman with massive upper gastrointestinal bleeding. Transjugular direct portal venogram shows duodenal varices (long black arrow) with afferent vessel originating in superior mesenteric vein (long white arrow) and accumulation of contrast agent (short black arrow) in duodenal lumen caused by persistent variceal hemorrhage. In addition, esophageal varices are visualized (short white arrow).

 


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  		Fig. 1D. —59-year-old woman with massive upper gastrointestinal bleeding. Direct digital subtraction venogram of superior mesenteric vein after transjugular intrahepatic portosystemic shunt placement and percutaneous embolization shows that duodenal varices are completely occluded.

 

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