Cervical Varizen

Cervical Varizen

Cervical Varizen Varizen uterine Ultraschall-Foto Cervical Varizen Krampfadern Video


Cervical Varizen

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Apr 25, Author: They are native veins that serve as collaterals to the central venous circulation when flow through the portal venous system or superior vena cava SVC is obstructed, Cervical Varizen. Esophageal varices are collateral veins within the wall of the esophagus that project directly into the Cervical Varizen. The veins are of clinical concern because they are prone to hemorrhage. Paraesophageal varices are collateral veins beyond the adventitial surface of the esophagus that parallel intramural esophageal veins.

Paraesophageal varices are less Cervical Varizen to hemorrhage. Esophageal and paraesophageal varices are slightly different in venous origin, but they are usually found together. Using a thin-barium technique, Cervical Varizen, radiographic appearances of esophageal varices were described first by Wolf in his paper, "Die Erkennug von osophagus varizen im rontgenbilde," or "Radiographic detection of esophageal varices.

Today, more sophisticated imaging with computed tomography CT scanning, Cervical Varizen, magnetic resonance imaging MRImagnetic resonance angiography MRACervical Varizen, and endoscopic ultrasonography EUS plays an important role in the evaluation of portal hypertension and esophageal varices.

Endoscopy is the Cervical Varizen standard for evaluating esophageal varices and assessing the bleeding risk. The procedure involves using a flexible endoscope inserted into Cervical Varizen patient's mouth and through the esophagus to inspect the Cervical Varizen surface. The esophageal varices are also inspected for red wheals, which are dilated intra-epithelial veins under tension and which carry a significant risk for bleeding.

The grading of esophageal varices and identification of red wheals by endoscopy predict a patient's bleeding Cervical Varizen, on which treatment is based. Endoscopy is also used for interventions. The following pictures demonstrate band ligation of esophageal varices.

CT scanning and MRI are identical in their usefulness in diagnosing and evaluating the extent of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. CT scanning and MRI are also valuable in evaluating the liver and the entire portal circulation.

These modalities are used in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in evaluating for a specific etiology of esophageal varices. These modalities also have an advantage over both endoscopy and angiography because they are noninvasive. CT scanning and MRI do not Cervical Varizen strict criteria for evaluating the bleeding risk, and they are not as sensitive or specific as endoscopy.

CT scanning and MRI may be used as alternative methods in making the diagnosis if endoscopy is contraindicated eg, Cervical Varizen, in patients with a recent myocardial infarction or any contraindication to sedation. In the past, angiography was considered the criterion standard for evaluation of the portal venous system. However, current CT scanning and MRI procedures have become equally sensitive and specific in the detection of esophageal varices and other abnormalities of the portal venous system.

Although the surrounding anatomy Cervical Varizen be evaluated the way they can be with CT scanning or MRI, angiography is advantageous because its use may be therapeutic as Cervical Varizen as diagnostic. Ultrasonography, excluding EUS, and nuclear medicine studies are of Cervical Varizen significance in the evaluation of esophageal varices.

Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique, Cervical Varizen.

Barium swallow examination is not a sensitive test, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention, Cervical Varizen.

However, in severe disease, esophageal varices may be prominent. CT scanning and MRI are useful in evaluating other associated abnormalities and adjacent anatomic structures in the abdomen or thorax.

On MRIs, surgical clips may create artifacts that obscure portions of the portal venous system, Cervical Varizen. Disadvantages of CT scanning include the possibility of adverse reactions to the contrast agent and an inability to quantitate portal Cervical Varizen flow, which is an advantage of MRI and ultrasonography.

Plain radiographic findings are insensitive and nonspecific in the evaluation of Anti-Cellulite-Körperpackung mit Krampfadern varices. Plain radiographic findings may suggest paraesophageal varices.

Anatomically, paraesophageal varices are outside the esophageal wall Cervical Varizen may create abnormal opacities. Esophageal varices are within the wall; therefore, Cervical Varizen, they are concealed in the normal shadow of the esophagus. Ishikawa et al described chest radiographic findings in paraesophageal varices in patients with portal hypertension, [ 14 ] and the most common was obliteration of a short or long segment of the descending aorta without a definitive mass shadow.

Other plain radiographic findings included a posterior mediastinal mass and an apparent intraparenchymal mass. Cervical Varizen other images, the intraparenchymal masses were confirmed to be varices in the region of the Cervical Varizen ligament, Cervical Varizen.

On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion Cervical Varizen the pulmonary vasculature. In addition, Cervical Varizen, a widened, Cervical Varizen, superior mediastinum may be shown. A widened, Cervical Varizen, superior mediastinum may result from dilated collateral veins or the obstructing mass.

Endoscopy is the criterion standard method for diagnosing esophageal varices. Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is not available see the images below. Pay attention to technique to optimize detection of esophageal varices.

The procedure should be performed with the patient in the supine or slight Trendelenburg position. Cervical Varizen positions enhance gravity-dependent flow and engorge the vessels.

The patient should be situated in an oblique projection and, therefore, in a right anterior oblique position to the image intensifier and a left posterior oblique position to the table, Cervical Varizen.

This positioning prevents overlap with the spine and further enhances venous flow. A thick barium suspension or paste should be used to increase adherence to the mucosal surface, Cervical Varizen. Cervical Varizen, single swallows of a small amount of barium should be ingested to minimize peristalsis and to prevent Cervical Varizen of the esophagus. If the ingested bolus is too large, the esophagus may be overdistended with dense barium, and the mucosal surface may be smoothed out, rendering esophageal varices invisible.

In addition, a full column of dense barium may white out any findings of esophageal varices, Cervical Varizen. Too many contiguous swallows create a powerful, Cervical Varizen, repetitive, stripping wave Cervical Varizen esophageal peristalsis that squeezes blood out of the varices as it progresses caudally.

Effervescent crystals may be used to provide air contrast, but crystals may also cause overdistention of Cervical Varizen esophagus with gas and thereby hinder detection of esophageal varices.

In addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small varices. The Valsalva maneuver may be useful to further enhance radiographic detection of esophageal varices. The patient is asked to "bear down as if you are having a bowel movement" or asked to Varizen Fotos von verschiedenen Stadien your stomach muscles as if you were doing a sit-up.

The Valsalva maneuver also traps barium in the distal esophagus and allows retrograde flow for an even coating. Plain radiographic findings suggestive of paraesophageal varices are very nonspecific. Any plain radiographic findings suggesting paraesophageal varices should be followed up with CT scanning or a barium study to differentiate the findings from a hiatal hernia, posterior mediastinal mass, Cervical Varizen, or other abnormality eg, rounded atelectasis, Cervical Varizen.

Similarly, barium studies or CT scan findings suggestive of esophageal varices should be followed up with endoscopy, Cervical Varizen. Endoscopic follow-up imaging can be used to evaluate the grade and appearance of esophageal varices to assess the bleeding risk, Cervical Varizen.

The results of this assessment direct treatment. In review case studies, a single thrombosed esophageal varix may be confused with an esophageal mass on barium studies. With endoscopy, the 2 entities can be differentiated easily.

The only normal variant is a hiatal hernia. The rugal fold pattern of a Cervical Varizen hernia may be confused with esophageal varices; however, Cervical Varizen, a hiatal hernia can be identified easily by the presence of the B line marking the gastroesophageal junction.

CT scanning is an excellent method for detecting moderate to large esophageal varices and for evaluating the entire portal venous system. CT scanning is a minimally invasive imaging modality that involves the use of only a peripheral intravenous line; therefore, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system see the images below.

A variety of techniques have been described for the CT evaluation of the portal venous system. Most involve a helical technique with a pitch of 1. The images are reconstructed in 5-mm increments. The Cervical Varizen of contrast material and the delay time are slightly greater than those in conventional helical CT scanning of the abdomen, Cervical Varizen.

The difference in technique Cervical Varizen adequate opacification of both the portal venous and mesenteric arterial systems, Cervical Varizen. On nonenhanced studies, esophageal varices may not be depicted well. Only a thickened esophageal wall may be found. Paraesophageal varices may appear as enlarged lymph nodes, posterior Cervical Varizen masses, Cervical Varizen, or a collapsed hiatal hernia. On Cervical Varizen images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus.

The appearance of paraesophageal is identical, but it is parallel to the esophagus instead of projecting into the lumen. Paraesophageal varices are easier to detect than esophageal varices because of the contrast of the surrounding lung and mediastinal fat. On contrast-enhanced CT scans, downhill esophageal varices may have an appearance similar to that of Cervical Varizen varices, varying only in location. Because the etiology of downhill esophageal varices is usually secondary to superior vena cava SVC obstruction, the physician must be aware of other potential collateral pathways that may suggest the diagnosis.

Stanford et al published data based on venography, [ 19 ] describing 4 patterns of flow in Cervical Varizen setting of SVC obstruction as follows [ 19 ]:. In a retrospective investigation, Cihangiroglu et al analyzed CT scans from 21 studies of patients Cervical Varizen SVC obstruction [ 20 ] and described as many as 15 Cervical Varizen collateral pathways.

Of their total cohorts, only 8 could be characterized by using the Stanford classification. In the setting of SVC obstruction, the most common collateral pathways were the in decreasing order of frequency: In a study by Zhao et al of row multidetector CT portal venography for characterizing paraesophageal varices in 52 patients with portal hypertensive cirrhosis and esophageal varices, [ Schafstiefel von Krampfadern kaufen ] 50 of the 52 cases showed an origin from the posterior branch of left gastric vein, whereas the others were from the anterior branch.

Fifty cases demonstrated their locations close to the esophageal-gastric junction; the other 2 cases were extended to the inferior bifurcation of the trachea. Forty-three patients in the Zhao et al study showed the communications between paraesophageal varices and periesophageal varices, whereas the hemiazygous vein 43 cases and IVC 5 cases were also involved. CT scanning is a minimally invasive method used to detect moderate to large esophageal varices Prävention von Krampfadern Kompressionsstrümpfe to evaluate the entire portal venous system, Cervical Varizen.

CT scans Cervical Varizen help in evaluating the liver, other venous collaterals, details of other surrounding anatomic structures, and the patency of the portal vein. In these situations, CT scanning has a major advantage over endoscopy; however, unlike endoscopy, CT scans are not useful in predicting variceal hemorrhage. Compared with angiography, CT scanning is superior in detecting paraumbilical and retroperitoneal varices and at providing a more thorough examination of the portal venous system without the risk of intervention.

In the detection of esophageal varices, CT scanning is slightly better than angiography. CT scanning and angiography are approximately equal in the detection of varices smaller than 3 mm. If CT scans do not demonstrate small varices, they are unlikely to be seen on angiograms. Contrast-enhanced CT scanning is essential for evaluating esophageal varices.

Contrast enhancement greatly increases the sensitivity and Cervical Varizen of the examination and reduces the rate of false-positive or false-negative results.


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