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A thrombus in the splenic vein causes the venous out flow to return to the portal vein by the way of low pressure collaterals namely the short gastric veins, the veins of the upper half of the stomach, the coronary vein and the gastroepiploic veins [ 3].
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This is made positioning two intravascular devices to stop both the arterial in-flow and the venous out-flow of the site where the tumor is localized.
However, orbital cavernous haemangiomas have recently been classified as type 3 low-flow arteriovenous malformations with a direct arterial in-flow and venous out-flow mechanism (arterial low-flow type) rather than as true neoplasms or proliferating hamartomas [ 15], and, to our knowledge, there is no evidence of malignant transformation in the literature.
CEUS revealed arterial rim enhancement around the necrotic mesenteric lymph nodes, without venous wash-out.
This lack of venous wash-out may be due to arborizing venules found in some peripheral T-cell lymphomas [ 22].
CEUS findings in EATL complicating CMLNS include arterial rim enhancement of the mesenteric tissue around the cavitating lymph nodes, without venous wash-out.
Patients disease free for at least 1 year (n=23) showed venous wash-out in 22 of 23 patients and whole-lesion hyperintensity b600 DWI in 18 patients.
This is the first report of a CEUS examination in CMLNS complicated with EATL that revealed an arterial rim enhancement around necrotic lymph nodes without venous wash-out.
This vascular pattern is not suggestive for neoangiogenesis, as arteriovenous shunts from malignant tissues are responsible for rapid venous wash-out of the contrast agent.
Perfusion imaging started with a bolus injection of Sonovue (2.4 ml), followed by analysis in the early arterial (wash-in) and late venous (wash-out) phase.
The intense, anarchic arterial enhancement with rapid venous wash-out of the contrast agent is highly suggestive for malignancy, since the malignant tissue is characterized by numerous arteriovenous shunts [ 8].
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Justyna Jupowicz-Kozak
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