Rare vascular conditions of abdominal circulation observed by three-dimensional color-doppler ultrasound

Background: Complex symptoms of abdominal vascular alterations are often missing. Abdominal Doppler US is the proper non-invasive method to prove it at early stage. The cause of the mechanical obstruction of vena cava or or major hepatic veins are mainly coagulopathy and tumors.

Patients and methods: 1st case: 48 yr old female patient was admitted to another hospital's department because of ascites and abdominal pain. Her history contained an operation of an adrenocortical oncocytaer adenoma of the adrenal gland, which was diagnosed as a semimalignant tumor. The 2D and 3D color Doppler US examination showed an irregular mass in the inferior vena cava. CT and MR examination suspected a tumor-like mass in the retroperitoneum. Results: The three-dimensional color-Doppler US showed the thrombus not only in the inferior caval but also in the hepatic veins. We applied a PET-CT examination which proved it as a metastatic tumor. A second operation was carried out and the adrenal gland tumor metastasis was successfully resected.

2nd case: A 24 yr old pregnant woman was admitted to the intensive care unit of our hospital because of jaundice and abdominal pain. The laboratory tests showed elevated liver enzimes and low platelet count. The Doppler and 3D US examinations found hepatomegaly, inhomogenous liver texture, dilated portal veins with portohepatic shunting and ascites. The clinical, laboratory and ultrasound signs supported the existing of HELPP syndrome. The patient had gastrooesophageal bleeding and required transfusion and supportive management. There were no signs of eclampsia and the delivery was successful without complications. The follow up examinations of our patient showed no of postal hypertension and diffuse liver disease any more.

Conclusion: The proper preoperative examination with 3D ultrasound can prove the cause of inferior vena cava or hepatic vein thrombosis, which could be essential for the diagnostic and therapeutic method of choice. In order to identify the HELPP syndrome the application of the above desribed method is more than important, it can save lives.