Mechanisms of development of splenic vein hypertension (IMAGE)
Caption
(A) Compression. Pancreatic cysts compress the splenic vein, increasing venous flow in the gastric veins and forming varices. Other causes of compression include pancreatic NET, lymphoma, SAA, Bochdalek hernia, enlarged lymph nodes, and RF. (B) Stenosis. Idiopathic splenic vein stenosis increases the venous blood flow in the gastric veins, forming varices. (C) Inflammation. Pancreatitis can lead to fibrosis with subsequent occlusion of the splenic vein, leading to increased flow to the gastric veins and the formation of varices. (D) Thrombosis. ET and PMF can lead to splenic vein thrombosis, increasing blood flow in the gastric veins with varix formation. (E) Surgically decreased splenic venous flow. PV-SMV resection performed in the setting of a pancreatic tumor can lead to increased congestion of the splenic vein with subsequent formation of gastric varices. ET, essential thrombocythemia; NET, neuroendocrine tumor; PMF, primary myelofibrosis; PV-SMV, portal vein-superior mesenteric vein; PV, portal vein; SAA, splenic artery aneurysm; SMV, superior mesenteric vein; SV, splenic vein; SVH, splenic venous hypertension.
Credit
Jasmine Tidwell, Bianca Thakkar, Bianca Thakkar
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License
CC BY-NC