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A Pericardiophrenic Collateral Pathway in Portal Hypertension
J Acute Care Surg 2019;9:25−26
Published online April 30, 2019;  https://doi.org/10.17479/jacs.2019.9.1.25
© 2019 Korean Society of Acute Care Surgery.

Dong Hun Kim, Hancheol Jo, Jeongseok Yun

Department of Surgery, Trauma Center, Dankook University Hospital, Cheonan, Korea
Dong Hun Kim, M.D.
Department of Surgery, Trauma Center, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea
Tel: +82-41-550-7661
Fax: +82-41-550-0039
E-mail: saint7331@gmail.com
ORCID: https://orcid.org/0000-0001-6613-6902
Received September 8, 2017; Revised October 23, 2017; Accepted November 22, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Body

A 70-year-old man sustained blunt trauma from rollover of a cultivator. Chest radiography showed irregular contour in the left lateral border of the heart (Fig. 1). Chest computed tomography (CT) revealed a markedly dilated pericardiophrenic vein passed along the lateral border of the heart, anastomosing to the left inferior phrenic vein and draining to the left brachiocephalic vein (Fig. 2). He had unknowingly liver cirrhosis, recognized by CT, with a Child-Pugh score of 8 (class B) caused by chronic Budd-Chiari syndrome (Fig. 3). This varicose vein may be usually due to the obstruction of the hepatic venous outflow [1]. Consequently, he had multiple fractures of left ribs with scanty pneumothorax and left renal rupture from trauma, followed by angiographic renal artery embolization. The engorged pericardiophrenic collateral pathway is a rare presentation from liver cirrhosis or Budd-Chiari syndrome [1-3], and direct traumatic injury to it probably could lead to the life-threatening massive hemothorax.

Fig. 1.

Chest radiography shows irregular margin and heterogenous radiopacity at the lateral border of the left heart


Fig. 2.

Chest computed tomography shows (A) a markedly engorged vessel (arrow) adjacent to the left ventricle in the mediastinum, (B) a dilated pericardiophrenic vein along the lateral border of the heart draining to the left brachiocephalic vein (arrow), and (C) dilatation of the left inferior phrenic vein (arrow) anastomosing to the pericardiophrenic vein.


Fig. 3.

Abdomen computed tomography shows liver cirrhosis with IVC obliteration, dilatation and outflow stenosis of common trunk of left and middle hepatic vein (black arrow), corresponding to imaging features of the Budd-Chiari syndrome (white arrow: left inferior phrenic vein, white arrowhead: azygos vein).


Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

References
  1. Sharma M, Rameshbabu CS. Collateral pathways in portal hypertension. J Clin Exp Hepatol 2012;2:338-52.
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  2. Kantarci M, Ogul H, Karaca L. A large pericardiophrenic collateral in a patient with Budd-Chiari syndrome. Eur J Cardiothorac Surg 2015;47:387.
    Pubmed CrossRef
  3. Widrich WC, Srinivasan M, Semine MC, Robbins AH. Collateral pathways of the left gastric vein in portal hypertension. AJR Am J Roentgenol 1984;142:375-82.
    Pubmed CrossRef


April 2019, 9 (1)
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