Question:

Which is true of percutaneous transhepatic portography?
1. Is diagnostically limited if a biliary stricture or stone is present.
2. Is the last resort if diagnosis by other imaging has failed.
3. Is exclusively used to evaluate intraluminal portal venous pathology.
4. Allows for fluid sampling in addition to imaging.
5. Will always show a pancreas-portal vein fistula.





Answer:

The correct answer for the question "Which is true of percutaneous transhepatic portography?" is:

4. Allows for fluid sampling in addition to imaging.



Explanation
1.    [ERCP cannot depict a fistula if there is not a direct connection between the pancreatic duct and the pseudocyst or if there is incomplete opacification of the pancreatic duct due to stricture or stone in the main duct.]

2.    [PTP was diagnostic in 4/17 cases and offered supplemental information in 4 other cases.]

3.    [PTP is used to treat portal vein thrombosis after major surgery and can also define the extent of major portal venous invasion by pseudocysts as well as tumors in the liver, pancreas and porta hepatis.]

4.    [In the current case, the tract from the pseudocyst to the portal vein was clearly identified using PTP, and the technique also allowed for the extraction of portal fluid for analysis.]

5.    [PTP was diagnostic in 4/17 cases and offered supplemental information in 4 other cases.]



From the manuscript:
Diagnosis of pancreatic duct-portal vein fistula; a case report and review of the literature
Radiology Case. 2014 Mar; 8(3):31-38


This article belongs to the Interventional section.




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From the manuscript

Diagnosis of pancreatic duct-portal vein fistula; a case report and review of the literature

Free full text article: Diagnosis of pancreatic duct-portal vein fistula;  a case report and review of the literature

Abstract
Pseudocysts containing activated enzymes are a common complication of pancreatitis. Pseudocysts can rupture into adjacent structures including the peritoneal cavity, adjacent organs, and rarely vascular structures. While arterial pseudoaneurysms and venous thrombosis or occlusion are well known complications of acute and chronic pancreatitis, only 17 cases of pancreas-portal venous fistula have been encountered in review of the literature. A patient with chronic pancreatitis presented with a history of weight loss, fatigue and was found to have a pancreatic duct-portal vein fistula. The patient was treated surgically with good outcome.






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