Aikawa H, Mori H, Miyake H, Yoshida S, Takaki H, Komatsu E, Tanaka R, Maeda T, Hirano M, Himeno K
Department of Radiology, Oita Medical University.
Nihon Shokakibyo Gakkai Zasshi. 1994 Aug;91(8):1320-7.
In 10 adult patients with hepatic portal venous gas (HPVG), the clinical significance of HPVG and the efficacy of X-ray computed tomography (CT) were evaluated. HPVG was associated with ischemic bowel disease (n = 3), trauma (n = 4), liver abscess (n = 1), sepsis (n = 1), and unknown etiology (n = 1). The diagnostic ability of CT for the detection of HPVG was far superior to that of plain abdominal radiograph. Of 9 patients who underwent CT, HPVG located in the left hepatic lobe in all patients, and also in right hepatic lobe in 7 patients. Gas could be recognized in the left lobe and the anterior segment of the right lobe more clearly than in the posterior segment of the right lobe because of its larger amount of intravenous collection. The mortality rate of our cases was 100%. Gas was demonstrated simultaneously in the portal vein radicles and hepatic veins on CT in 4 patients with no clinical evidence of sepsis, which suggested the possibility of intraparenchymal shift of gas from the portal vein into the hepatic vein. In a single case with sepsis, gas was noted in various vessels, including arteries, in addition to the portal venous system. The authors conclude that HPVG is still a grave sign in Japan and prompt appropriate treatment is required. CT may be of great value in the early detection of HPVG and may indicate its etiology.
在10例患有肝门静脉积气（HPVG）的成年患者中，评估了HPVG的临床意义以及X线计算机断层扫描（CT）的疗效。HPVG与缺血性肠病（n = 3）、创伤（n = 4）、肝脓肿（n = 1）、脓毒症（n = 1）以及病因不明（n = 1）有关。CT检测HPVG的诊断能力远优于腹部平片。在接受CT检查的9例患者中，所有患者的HPVG均位于左肝叶，7例患者的HPVG还位于右肝叶。由于左叶和右叶前段的静脉血汇集量较大，因此在这些部位比右叶后段能更清晰地识别气体。我们病例的死亡率为100%。4例无脓毒症临床证据的患者在CT上显示门静脉分支和肝静脉同时出现气体，这提示气体可能从门静脉实质内转移至肝静脉。在1例脓毒症患者中，除门静脉系统外，在包括动脉在内的各种血管中均发现了气体。作者得出结论，在日本，HPVG仍然是一个严重的体征，需要及时进行适当治疗。CT在HPVG的早期检测中可能具有重要价值，并可能提示其病因。
