Barium Sulfate Solution Research Articles

The superior and inferior mesenteric veins as collateral channels in inferior vena cava obstruction.

Morgagni (8) in 1769 first documented collateral circulation in a case of obstructed inferior vena cava. Ferris et at. (2) reported that collateral pathways to the portal system occur via the superior hemorrhoidal veins to the inferior mesenteric vein. This pathway has been radiographically demonstrated in four cases (4, 6). Missal et at. (7) and Pleasants (9) noted inferior vena cava-to-portal vein anastomoses by way of the left renal-spermatic veins and the superior hemorrhoidal veins to the “mesenteric” veins. The infrequently mentioned collateral pathways from the right kidney are via the perinephric and capsular veins to the right subcostal vein and from the left kidney mainly into the inferior hemiazygos venous system (5, 7). By means of roentgenography and dissection after postmortem injections of barium sulfate solution into the femoral vein, Edwards (1) demonstrated poor filling of the possible collateral pathways to the superior mesenteric vein. Because of embryologic juxtaposition of the visceral and systemic vascular plexuses, there can be communications between the veins of the mesentery of the portal venous system and those derived from the subcardinal veins, including the gonadal veins (1, 3, 10). The case presented is unique in that for the first time, the collateral pathways to the superior and inferior mesenteric veins were demonstrated during inferior vena cavography. Case Report N. S., a 14-year-old Caucasian female, had an unresectable Wilms's tumor of the right kidney obstructing the inferior vena cava. Four weeks postirradiation of the right hemiabdomen, a catheter was introduced to the distal inferior vena cava by the Seldinger technic, and 150 cc of 60 per cent methylglucamine diatrizoate (Renografin 60) was injected with 150 p.s.i. of pressure. Figure 1 shows the contrast material filling both common iliac veins and the inferior vena cava to the level of the renal veins. There is no filling of the right renal vein or the proximal portion of the inferior vena cava. The left renal vein is opacified. From here, contrast medium flows to the inferior hemiazygos system. In addition, there is filling of the ascending lumbar and vertebral venous systems from the inferior vena cava and from both common iliac veins. The right ovarian vein is opacified in a retrograde manner, filling an ovarian venous plexus. The inferior mesenteric vein is faintly seen, arising from the superior hemorrhoidal veins on the left. On later films (Figs. 2 and 3) mesenteric collaterals arising from the right ovarian venous plexus fill the superior mesenteric vein, which then flows into the portal vein. The well opacified inferior mesenteric vein flows into the splenic vein. In addition, collaterals arising from the right ovarian venous plexus appear to drain the right renal capsule and perinephric area and flow into the right subcostal vein. Discussion This case demonstrates that the superior and inferior mesenteric veins can form functionally significant collateral pathways between the inferior vena cava and the portal circulation.

Pulmonary venous vasculature in neonatal hyaline membrane disease.

The pulmonary veins and venules in lungs of newborn infants with hyaline membrane disease can be completely filled with a barium sulfate solution. The same injection technique and combined roentgenological, histological, and histometrical investigations also reveal a defect in filling of many small muscular arteries and of most pulmonary arterioles. Hence, the latter pulmonary vessels are assumed to be important in pulmonary ischemia, as demonstrated in the respiratory distress syndrome of the newborn infant.

Pulmonary arterial vasculature in neonatal hyaline membrane disease.

Many small muscular pulmonary arteries and most pulmonary arterioles in lungs of newborn infants with hyaline membrane disease cannot be filled with a barium sulfate solution. In the control group, composed of normal, 4-day-old lambs, such vessels were easily and completely injected. Hence these vessels are supposed to play an important role in the pulmonary hypoperfusion, recently demonstrated in the respiratory distress syndrome of the newborn.

Functional anatomy of the porta-systemic communications.

THE CURRENT renewed interest in the problems of portal and caval obstruction prompts a reexamination of the anatomy of the communications between the portal and the systemic veins. This report is based on roentgenography and dissection of the communications after their postmortem injection with barium sulfate solution via the femoral veins and inferior caval system in human subjects. The study affords a basis for evaluation of the relative importance of the various possible collaterals. Briefly, the findings indicate that the deep pathways in the pelvis, abdomen and thorax are normally patent and are of greater importance than the anterior parietal ones. The role of porta-systemic communications as collaterals in portal obstruction will be discussed at length. Briefer attention will be paid to the utilization of the portal system as a collateral pathway after obstruction of the venae cavae. HISTORICAL STATEMENT The normal existence of multiple porta-systemic connections has been known