Periportal lymphatic distension resulting from cardiac tamponade: CT findings and clinical-pathologic correlation

Abstract

Purpose: To correlate computed tomography (CT) findings with clinical-pathologic results and discuss the possible significance of periportal hypodensity in patients with clinical cardiac tamponade secondary to acute proximal thoracic aortic dissection, aneurysm, or heart rupture. Materials and methods: In a retrospective review of thoracoabdominal CT scans and records of 17 consecutive patients with hemopericardium, 10 patients with clinical signs of cardiac tamponade associated with hypodensity around the portal vein were selected; at surgery or autopsy all 10 patients had a thoracic aortic aneurysm, dissecting aneurysm, and heart rupture. The ratio of transverse inferior vena cava diameter to the diameter of the aorta at the level of the right adrenal gland was determined. Results: Abdominal CT scans showed focal (n = 1) or diffuse (n = 9) areas of hypodensity around the portal vein associated with pericaval hypodensity in four cases. Other abdominal abnormalities included persistent enhancement of renal parenchyma (n = 5), and gallbladder wall edema (n = 2); in nine cases the inferior vena cava diameter was significantly increased compared with that of patients with normal findings on CT scans (P < 0.01). Pathologic correlation, available in nine cases by autopsy, showed evidence of periportal lymphatic vessel dilatation and lymphedema. Conclusions: Periportal hypodensity on CT scans corresponds to the histopathologic picture of dilated lymphatic vessels or hepatic lymphedema; a diagnosis of hepatic lymphedema may be considered on the basis of CT scans in patients with pericardial effusion.