technetium-tc-99m-sulfur-colloid and Hypertension--Portal

A hepatic hydrothorax is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. The pleural effusion is derived from ascitic fluid that enters the chest because of the negative pressure within the pleural space via defects in the diaphragm. The peritoneal-to-pleural flow of fluid can be demonstrated by nuclear scanning, even when the ascites is not clinically apparent. The pleural fluid usually has the characteristics of a transudate. However, an occasional patient with hepatic hydrothorax will develop spontaneous bacterial pleuritis manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. Treatment of the hydrothorax is directed at the underlying liver disease but a dyspneic patient can obtain relief from a thoracentesis or paracentesis. When medical therapy fails, liver transplantation is the treatment of choice. Both transjugular intrahepatic portosystemic shunting and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality of these procedures are high because of the fragile nature of the patients.

Topics: Humans; Hydrothorax; Hypertension, Portal; Liver Cirrhosis; Liver Transplantation; Paracentesis; Portasystemic Shunt, Transjugular Intrahepatic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Thoracoscopy

Hypertension may be a cause of sepsis, especially among cirrhotic patients.. In the present investigation we studied the response of the mononuclear phagocytic system in 25 female Holtzman rats divided into five groups of 5 animals each: A, sham-operated animals; and animals with portal hypertension induced by calibrated ligature of the portal vein at different times of evolution: B, 15 days; C, 30 days; D, 45 days; E, 60 days. After the period of observation, 1 MBq/kg 99mTc colloidal sulfur was injected through the caudal vein and the animals were sacrificed 30 minutes later. Blood samples were obtained for GOT, GPT and albumin determination and radioactive counts, and liver, lung, spleen and bone marrow samples were obtained for the determination of the proportional phagocytosis index per gram organ. The results were analyzed statistically by the Kruskal-Wallis test.. Increased radioactivity was observed in bone marrow and spleen and higher GPT levels were detected after 15 days. A reduction of splenic phagocytosis, an increase of pulmonary phagocytosis and increased GPT levels occurred after 30 days. In the 45-day group there was an increase in non-phagocytized particles remaining in blood, and in the 60-day group there was only and increase in GPT values.. We conclude that portal hypertension causes phagocytic alterations during the early phases in this experimental model.

Topics: Animals; Data Interpretation, Statistical; Female; Hypertension, Portal; Liver; Liver Circulation; Macrophages; Phagocytosis; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Technetium Tc 99m Sulfur Colloid

A prospective study of 101 consecutive patients of portal hypertension was carried out to study the possible relationships between bone marrow activity on 99m technetium labelled sulphocolloid scan and severity of liver disease, etiology of portal hypertension and cirrhosis, as well as presence and extent of collateral circulation, including esophageal varices. The patients were divided into 4 etiological groups: alcoholic cirrhosis (ALD), (38) non-alcoholic cirrhosis (NALD) (35) non-cirrhotic portal fibrosis (NCPF) (14) and extrahepatic portal vein obstruction (EHPVO) (14). Patients of cirrhosis were categorised according to modified Child-Pugh's classification. Esophageal varices were graded endoscopically as (1) no varix (2) small varices (< 5mm) (3) large varices (> 5mm). All patients underwent radionuclide imaging using 99m Technetium labelled sulphocolloid and bone marrow activity was studied. Evaluation of portasystemic collaterals was done ultrasonically. We found that 16.6%, 44.6% and 72.72% patients with Child A, B and C cirrhosis respectively, had increased marrow activity (p < 0.05). There was no significant difference between marrow activity of patients with ALD (52.6%) and NALD (40%). None of the non-cirrhotic patients demonstrated bone marrow uptake of radioisotope. There was no significant difference between bone marrow uptake presence of lienorenal collaterals and presence or size of esophageal varices. We thus conclude the bone marrow activity on radioisotope scanning depends only on the severity of liver disease and does not vary a according to the etiology of cirrhosis, or presence and extent of portasystemic collaterals, including esophageal varices.

Topics: Adult; Bone Marrow; Case-Control Studies; Collateral Circulation; Esophageal and Gastric Varices; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Male; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

To evaluate gastric emptying in patients with chronic liver disease and portal hypertension.. We measured gastric emptying of both the liquid and solid components of a meal in 10 consecutive patients with chronic liver disease and portal hypertension, but free of ascites, and 14 age- and sex-matched healthy controls. In the patients with liver disease, relationships between emptying and liver function were examined. To measure gastric emptying, subjects consumed a test meal that consisted of scrambled eggs labeled with 99mTc-sulfur colloid and 4 oz of water labeled with 111In-diethylene triamine pentacetic acid (DTPA).. Patients with liver disease and portal hypertension demonstrated delayed emptying of both the liquid (t1/2, min, mean +/- SE, patients vs.. 69.4 +/- 19.4 vs. 31.4 +/- 1.8, p < 0.01) and solid (post-lag phase solid emptying: 141 +/- 32.9 vs. 69.8 +/- 4.6, p < 0.006) components of the meal. We could not identify any correlation between gastric emptying and tests of liver function.. Gastric emptying is delayed in patients with liver disease and portal hypertension; this abnormal gastric motor function may contribute to the pathophysiology of foregut complaints in this patient population.

Topics: Adult; Chronic Disease; Female; Food; Gastric Emptying; Humans; Hypertension, Portal; Indium Radioisotopes; Liver Diseases; Liver Function Tests; Male; Middle Aged; Pentetic Acid; Technetium Tc 99m Sulfur Colloid

The increased incidence of infection in cirrhotics may in part be attributable to dysfunction of the reticuloendothelial system (RES) in removing pathogens from the circulation. The portosystemic shunting (PSS) that results from portal hypertension in cirrhotics may compromise RES function by allowing enteric pathogens to be shunted away from the Kupffer cells. A well-characterized model of portal hypertension induced by partial portal vein ligation (PVL), in which there is no hepatic parenchymal cell damage, was used. Kupffer cell function is unaltered and the effect of PSS alone on overall RES function can be evaluated. In addition to the usual immunologically inert [99mTc]sulfur colloid, an actual pathogen was also evaluated. PVL and sham-ligated rats were given either [99mTc]sulfur colloid or E. coli via the ileocolic vein. The right femurs, lungs, livers and spleens of the animals receiving 99mTc were excised and the radioactivity counted. The lungs, livers, and spleens of the animals receiving E. coli were liquefied and the bacteria were quantified. For both groups the ratios of 99mTc or E. coli in the lung, spleen, and femur to liver were calculated. PVL rats had significantly more 99mTc in the lung, spleen, and femur than the sham rats. There were also significantly more E. coli in the lungs for PVL rats but no significant difference in the spleen counts. These results imply that even in the absence of Kupffer cell dysfunction, PSS alters reticuloendothelial system function by causing a greater distribution of pathogens to the periphery. This altered distribution may contribute to an increased susceptibility to infection in cirrhotics.

Topics: Animals; Escherichia coli Infections; Hypertension, Portal; Kupffer Cells; Male; Mononuclear Phagocyte System; Radionuclide Imaging; Rats; Rats, Sprague-Dawley; Technetium Tc 99m Sulfur Colloid; Tissue Distribution

Various criteria are used together for the scintigraphic diagnosis of cirrhosis as no single criterion may be reliable. However, low right-to-left hepatic lobe uptake ratio has been reported to be sensitive and specific for alcoholic cirrhosis. A low liver-to-spleen uptake ratio has also been reported in various hepatocellular disorders. We tested these ratios in patients with cirrhosis and non cirrhotic causes of portal hypertension. The right-to-left lobe uptake ratio was significantly lower (1.59 +/- 1.23 vs 2.36 +/- 0.63 in normals; p = 0.037) in only Child's C alcoholic cirrhosis, but the sensitivity of this ratio was low (40%) even in this subgroup of cirrhosis (mean +/- SD 1.72 +/- 1.08) as against 1 of 10 patients with non cirrhotic portal hypertension (3.57 +/- 1.33; p = 0.0005). We conclude that the right-to-left hepatic lobe uptake ratio is not a discriminatory scintigraphic sign in liver disease. A low liver-to-spleen uptake ratio can distinguish cirrhosis from non cirrhotic causes of portal hypertension.

Topics: Diagnosis, Differential; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Sensitivity and Specificity; Spleen; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Male; Portal System; Radionuclide Imaging; Schistosomiasis; Technetium Tc 99m Sulfur Colloid

A simple reproducible animal model of extrahepatic portal hypertension (EHPHT) has been developed in weanling Wistar rats using a two-stage ligation of the portal vein. This model consistently produces substantial collaterals, both portosystemic (hepatofugal) and portoportal (hepatopetal). Using dynamic hepatic scintigraphy (DHS) with 99mTechnetium sulphurcolloid, hepatopetal collateral flow was measured as the mesenteric fraction (MF) of total hepatic blood flow and compared with measurement of hepatofugal collateral flow (portosystemic shunting) following intraportal injection of radiolabeled microspheres. Strong and significant correlation between the two assessments was found with reduction in MF denoting increased portosystemic shunting (PSS). The technique of DHS has been used successfully in adults to assess compromised portal venous flow and is a simple noninvasive test to aid diagnosis, assessment, and follow-up of children with EHPHT.

Topics: Animals; Collateral Circulation; Disease Models, Animal; Hypertension, Portal; Ligation; Liver Circulation; Mesenteric Veins; Portal System; Portal Vein; Radiography; Radionuclide Imaging; Rats; Rats, Inbred Strains; Regional Blood Flow; Technetium Tc 99m Sulfur Colloid; Venous Pressure

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.

Topics: Chylothorax; Chylous Ascites; Humans; Hypertension, Portal; Lymphedema; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

We report a case of hepatic portal venous hypertension secondary to a small-bowel vascular malformation in a 24-year-old man with anemia. Preoperative diagnostic evaluation included gastrointestinal barium studies and endoscopy (showing esophageal varices), hepatic panangiography, peroral small-bowel biopsy, percutaneous transhepatic portal venography, and manometry. Preoperative injection of methylene blue dye into the jejunal arteries supplying the malformation resulted in easy localization of the lesion at surgery. Direct manometry at the time of segmental jejunal resection yielded a portal pressure of 35 mmHg, with subsequent reduction to 21 mmHg.

Topics: Adult; Angiography; Arteriovenous Malformations; Endoscopy; Humans; Hypertension, Portal; Jejunum; Male; Manometry; Methylene Blue; Microspheres; Phlebography; Preoperative Care; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

After undergoing therapeutic transcatheter embolization of the splenic artery for treatment of portal hypertension, 11 consecutive patients were evaluated with sulfur colloid scintigraphy and real-time sonography of the left upper quadrant to determine which method was better for follow-up evaluation of the spleen. Six splenic infarcts were documented by both imaging methods; sonography, however, demonstrated the characteristic wedge shape of the infarct in four of the six cases. There were no cases of splenic abscess formation. Sonography should be the primary method for evaluation of the spleen after transcatheter embolization and can help in planning treatment to avoid abscess formation.

Topics: Abscess; Acute Disease; Diagnosis, Differential; Embolization, Therapeutic; Follow-Up Studies; Humans; Hypertension, Portal; Radionuclide Imaging; Splenic Infarction; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Topics: Collateral Circulation; Humans; Hypertension, Portal; Liver; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Umbilical Veins

Topics: Colloids; Female; Humans; Hypertension, Portal; Liver Circulation; Liver Cirrhosis; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Umbilical Veins

We recently developed a radiocolloid technique for quantifying the fraction of superior mesenteric venous blood that bypasses liver sinusoids through extra- and intrahepatic collateral vessels. In the present investigation we applied this method, which is performed in conjunction with visceral angiography, to the assessment of patients with portal hypertension before and after surgical construction of portasystemic shunts. The mean corrected shunt index was 0.89 in 27 preoperative patients, and 48 percent of the patients had no evidence of sinusoidal perfusion by superior mesenteric venous blood (shunt index greater than 0.95). Sinusoidal perfusion was absent in five patients with residual hepatic portal flow by angiography, indicating that they had a high degree of intrahepatic shunting. Hepatic portal perfusion was preserved in 80 percent of patients after distal splenorenal shunt, and the corrected shunt index was significantly smaller after this procedure than after portacaval and interposition shunts. . Three patients with no sinusoidal perfusion by superior mesenteric blood preoperatively had restoration of portal flow after distal splenorenal shunt. Five patients undergoing portacaval and interposition shunts had no evidence of portal sinusoidal perfusion by the radiocolloid technique either before or after the operative procedure.

Topics: Angiography; Collateral Circulation; Colloids; Humans; Hypertension, Portal; Liver Circulation; Mesenteric Veins; Portal System; Portasystemic Shunt, Surgical; Splenorenal Shunt, Surgical; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid