Avoiding Booby-traps: Tricky Findings in Liver Transplantation Imaging

LL-GIE-SU8A

Avoiding Booby-traps: Tricky Findings in Liver Transplantation Imaging—A Review of Pitfalls with Solutions

Education Exhibits

Presented on November 25, 2012
Presented as part of LL-GIE-SU: Gastrointestinal Lunch Hour CME Exhibits

Adeel Rahim Seyal MD, Abstract Co-Author: Nothing to Disclose

Neeraj Lalwani MD, Abstract Co-Author: Nothing to Disclose

Rupan Sanyal MD, Abstract Co-Author: Nothing to Disclose

Orpheus Kolokythas MD, Abstract Co-Author: Research Grant, Koninklijke Philips Electronics NV Consultant, Koninklijke Philips Electronics NV Advisory Board, Koninklijke Philips Electronics NV Research Grant, Bracco Group Equipment Grant Supersonic Imagine

Manjiri K. Dighe MD, Abstract Co-Author: Nothing to Disclose

Puneet Bhargava MBBS, Presenter: Nothing to Disclose

Sandeep Vaidya MD, Abstract Co-Author: Nothing to Disclose

Chandana G. Lall MD, Abstract Co-Author: Nothing to Disclose

1. Lack of awareness of the variant vascular anatomy, surgical techniques, evolving Doppler changes in the immediate postoperative period, and often leads to misdiagnosis and unnecessary workup. 2. We will review pitfalls of liver transplantation imaging workup and outline problem solving approaches.

The following scenarios will be reviewed. 1. A review of normal changes in the first 72 hours of liver transplantation. 2. “Fish-mouth” hepatic artery anastomosis mistaken for a pseudoaneurysm. 3. Difference in anastomotic caliber and tortuosity confused with stenosis. 4. Spasm versus occlusion. Role of nifedipine and US contrast. 5. Chronic arterial occlusion with intrahepatic tardus-parvus waveform. 6. Pseudoaneurysm versus seroma. Role of Doppler. 7. Air in the biliary tree from hepaticojejunostomy. A review of variant biliary anastomosis. 8. “Shelf-like” anastomotic portal vein ring mistaken for dissection. 9. Positional IVC waveform changes. 10. Abscess versus infarct. Role of biopsy. 11. Changes in rejection.

1. After reviewing the exhibit the viewer will be familiar with the common pitfalls of imaging in liver transplantation. 2. Problem solving approaches to these scenarios will be discussed along with a current review of the literature.

Seyal, A, Lalwani, N, Sanyal, R, Kolokythas, O, Dighe, M, Bhargava, P, Vaidya, S, Lall, C, Avoiding Booby-traps: Tricky Findings in Liver Transplantation Imaging—A Review of Pitfalls with Solutions. Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12027954.html