Paraumbilical Vein Research Articles

Umbilical hernia with uncommon content; herniated paraumbilical collateral veins.

Umbilical hernia with uncommon content; herniated paraumbilical collateral veins.

Focal hepatic hot spot sign: Clinical image

A 51‐year‐old women was hospitalized to start chemotherapy for small cell lung cancer diagnosed one months earlier. She underwent Computed Tomography (CT) of the chest and abdomen to re‐evaluate the progression of the lung tumour. Contrast-enhanced CT of the chest indicated an invasive anterior left lung tumour that caused an obstruction of the Superior Vena Cava (SVC) (Figure 1). Contrast-enhanced CT of the abdomen revealed an intense focal wedge-shaped homogeneous enhancement area in the quadrate lobe of the liver, which is known as the hot spot sign (Figure 2). Focal hepatic hot spot sign was first described by Ishikawa in 1983. The sign can be observed on technetium 99m (99mTc) Sulphur colloid scans or on contrast, material enhanced CT scans [1]. Hot spot sign is caused by portosystemic venous shunting between the superior vena cava and the left portal vein via the internal mammary and paraumbilical veins along the ligamentum teres, secondary to superior vena cava obstruction. The hot spot is created by areas of focally increased blood flow that result from this shunting [2]. Stanford and colleagues classified SVC syndrome into four types - type I and type II referred as supra-azygous partial and near complete obstruction of SVC with antegrade flow in azygous vein. Type III is defined as complete obstruction of SVC with reversal of azygous blood flow and type IV as complete obstruction of SVC and azygous system with development of chest wall collaterals [3]. This sign has been reported in Budd-Chiari syndrome, the causes of SVC syndrome (neoplasms of the thorax as lung carcinoma and lymphoma, Vasculo‐Behcet’s disease, fibrosing mediastinitis, and luetic aneurysm), and masses of the liver (abscess, haemangioma, focal nodular hyperplasia, and hepatocellular carcinoma) [4].

Combination of transjugular intrahepatic portosystemic shunt and antegrade through-the-TIPS coil embolization for bleeding mixed-type ectopic ileal varices

A 61-year-old man with alcoholic cirrhosis and a history of severe cholecystitis leading to secondary thrombosis of the recanalized paraumbilical vein was admitted to our hospital for recurrent gastrointestinal bleeding and severe anemia. Capsule endoscopy and CT angiography detected profuse bleeding in the proximal ileum from ectopic ileal varices. Hepatic venous-portal gradient (HVPG) measurement was consistent with severe portal hypertension. Persistent bleeding despite transjugular intrahepatic portosystemic shunt (TIPS) placement required a combined approach with antegrade through-the-TIPS coil embolization of the ileal varices.

Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement.

Background: This study aimed to evaluate whether a large paraumbilical vein (L-PUV) was independently associated with the occurrence of overt hepatic encephalopathy (OHE) after the implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Methods: This bi-center retrospective study included patients with cirrhotic variceal bleeding treated with a TIPS between December 2015 and June 2021. An L-PUV was defined in line with the following criteria: cross-sectional areas > 83 square millimeters, diameter ≥ 8 mm, or greater than half of the diameter of the main portal vein. The primary outcome was the 2-year OHE rate, and secondary outcomes included the 2-year mortality, all-cause rebleeding rate, and shunt dysfunction rate. Results: After 1:2 propensity score matching, a total of 27 patients with an L-PUV and 54 patients without any SPSS (control group) were included. Patients with an L-PUV had significantly higher 2-year OHE rates compared with the control group (51.9% vs. 25.9%, HR = 2.301, 95%CI 1.094−4.839, p = 0.028) and similar rates of 2-year mortality (14.8% vs. 11.1%, HR = 1.497, 95%CI 0.422−5.314, p = 0.532), as well as variceal rebleeding (11.1% vs. 13.0%, HR = 0.860, 95%CI 0.222−3.327, p = 0.827). Liver function parameters were similar in both groups during the follow-up, with a tendency toward higher shunt patency in the L-PUV group (p = 0.067). Multivariate analysis indicated that having an L-PUV (HR = 2.127, 95%CI 1.050−4.682, p = 0.037) was the only independent risk factor for the incidence of 2-year OHE. Conclusions: Having an L-PUV was associated with an increased risk of OHE after a TIPS. Prophylaxis management should be considered during clinical management.

Umbilical cord vessels other than the umbilical arteries and vein: a histological study of midterm human fetuses.

At birth, the umbilical cord contains various types of thin vessels that are near and outside the umbilicus and separate from the umbilical arteries and vein. These vessels are regarded as the remnant "vitelline vessels" and are often called "umbilical vessels", although this terminology could lead to confusion with the true umbilical arteries and vein. No study has yet comprehensively examined these vessels using histological sections. Our examination of these vessels in 25 midterm fetuses (gestational age: 10-16 weeks) led to five major findings: (i) all specimens had umbilical branches of the inferior epigastric artery; (ii) 5 specimens had vitelline vein remnants; (iii) 4 specimens had a thin artery originating from the left hepatic artery that ran along the umbilical vein; (iv) 2 specimens had a so-called "para-umbilical vein" that was along the umbilical vein and reached the umbilicus; and (v) all specimens had lymphatic vessels originating from the umbilicus that ran caudally along the umbilical artery. The pelvic vein tributaries were well developed along the intra-abdominal umbilical artery, but did not reach the umbilicus. The lymphatic vessel was distinguished from the veins by an intraluminar cluster of lymphocytes attaching to the endothelium. The arterial branch in the umbilical cord did not accompany veins and lymphatic vessels, in contrast to the mother artery in the rectus abdominis. All these thin vessels seemed to be obliterated when the fibrous umbilical ring grew during late-term. The para-umbilical collateral vein in adults might develop outside the fibrous umbilical ring after birth.

Cruvelier-Baumgarten Syndrome Type II in Combination with Arteriovenous Splenic Artery Fistula: Literature Review and Clinical Case

Cruvelier-Baumgarten syndrome is a rare disease that causes portal hypertension in association with unclogged umbilical or paraumbilical veins, hypoplasia of the intrahepatic portal system, and liver atrophy with minimal or no fibrosis. Patients with this condition experience the classic signs of portal hypertension such as gastrointestinal bleeding, ascites, and encephalopathy. Frequent clinical manifestations are the symptom of "jellyfish head" and venous murmur over the umbilical region due to the presence of large umbilical and paraumbilical veins. In the presented clinical case of Cruvelier-Baumgarten syndrome type II in combination with splenic artery arteriovenous fistula, pathological changes were not pronounced. There was no "jellyfish head" symptom, but a venous murmur was heard in the umbilical region. The patient complained of moderate pain in the epigastrium, right hypochondrium. Examination of the patient, which revealed, in addition to the typical manifestations of this disease, also multiple SAVFs, as well as angiography data regarding pressure in the umbilical vein - 5 mm Hg, determined the tactics of treatment in the volume of endovascular occlusion of the splenic artery branches, which was successfully completed. As a result, there was a decrease in pressure in the portal system and a sharp decrease in discharge through the recanalized umbilical vein into the basin of the inferior vena cava, which made it possible to level out complaints. At the control examination two months after treatment, the patient had no complaints. A review of the literature on the Cruveilhier-Baumgarten syndrome and disease is presented.

Embolisation of an enlarging paraumbilical vein aneurysm

Whilst recanalised Paraumbilical Veins (PUVs) are common pathways for decompression in patients with portal hypertension, aneurysmal change is rare, with only a handful of previously reported cases. A 47-year-old man with cirrhosis and portal hypertension was found to have an asymptomatic, but rapidly enlarging PV aneurysm. This was successfully treated with embolisation and this is the first time that this has been described.

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis.

Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Abdominal contrast-enhanced computed tomography is a major imaging approach to establish a diagnosis of SPSS and evaluate its location and feature. This review primarily describes the main contrast-enhanced CT features of SPSS in liver cirrhosis.

Transferosomal in situ gel administered through umbilical skin tissues for improved systemic bioavailability of drugs: A novel strategy to replace conventional transdermal route

Systemic bioavailability is of prime importance for most of the drugs that are administered via any route to produce required therapeutic efficacy. Many hydrophilic and lipophilic drugs have relied on parenteral and oral routes of administration for several treatments. However, these routes possess numerous disadvantages. Therefore, transdermal route of drug administration has come into existence as an alternative to parenteral and oral routes. Although many transdermal drug delivery systems have achieved better systemic bioavailability, they are associated with several disadvantages, such as poor skin permeability and retention. Additionally, the drugs that need to be administered in larger doses for sustained delivery are facing challenges. Generally, the transdermal formulations are applied on various skin regions (forearm, shoulder, thigh, back, etc.), other than the umbilicus, to deliver a drug into the systemic circulation. However, the supremacy of the umbilicus is that its skin tissues possess a thin stratum corneum and the presence of paraumbilical veins beneath the umbilical skin tissues enables rapid systemic distribution of drugs. The navel therapy has a practical history of more than 2000 years under Traditional Chinese Medicine. Several studies have witnessed the successful treatment of many digestive diseases by placing numerous herbal extracts on the umbilicus. An ample amount of works has compared the drug absorption through skin tissues at the umbilicus and forearm. Upon their results, it seemed the umbilicus could serve as an ideal region for better systemic bioavailability than other skin regions. Therefore, the present hypothesis aimed to put forward to deliver selected hydrophilic or lipophilic drugs through skin tissues at the umbilicus using a transferosomal in situ gel system for better systemic bioavailability than delivering drugs through other skin regions. Thus, the proposed hypothesis would produce better systemic bioavailability of many drugs.

A110 FEASIBILITY OF EUS-GUIDED PORTAL PRESSURE GRADIENT MEASUREMENT WITHOUT DEEP SEDATION: A PATH TO ACCURATE PORTAL PRESSURE DETERMINATION

AimsHepatic venous pressure gradient (HVPG) is the gold standard for the diagnosis and staging of portal hypertension. Previous studies have shown that it underestimates pre-sinusoidal portal hypertension. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) can safely measure direct portal vein pressure (PVP) and bridge this diagnostic gap. However, EUS-PPG has so far been performed with patients under deep sedation which can alter HVPG measurement and lead to misclassification of portal hypertension. Ketamine, a conscious sedation agent, has minimal effect on portal hemodynamics. We present our center’s experience with EUS-PPG under ketamine and low dose midazolam.MethodsWe retrospectively reviewed consecutive patients undergoing EUS-PPG with conscious sedation using ketamine and low-dose midazolam (<0.02 mg/kg) at the McGill University Health Centre from February to May 2021. Patients were placed in the left lateral position. Hepatic vein and portal vein were located through EUS via a trans-gastric/hepatic approach. A through the scope 25-gauge needle attached to a manometer was advanced through the liver to measure hepatic vein pressure (HVP) and portal vein pressure (PVP). Three measurements were sampled per vessel and mean pressure differences calculated to obtain PPG. PPG was considered reliable if the differences between the values was no more than 1mmHg.ResultsThree patients underwent EUS-PPG for evaluation of pre-sinusoidal portal hypertension. Cirrhosis was excluded in all patients based on recent liver biopsy or transient elastography. The first patient is a 69-year-old man with splenomegaly and recanalization of the paraumbilical vein on imaging. He received 80 mg of ketamine and no midazolam. HVPG measured was 1 mmHg. EUS-PPG was successful with PPG of 6 mmHg (HVP= 7 mmHg, and PVP= 13 mmHg). The second patient is a 42-year-old woman with previous sleeve gastrectomy and known with portal cavernoma. She received 120 mg of ketamine and 1 mg of midazolam. EUS-PPG was technically difficult due to respiratory movements. The measurement was not considered reliable as differences in PPG were as high as 2mmHg. In this case, PPG was 0mmHg (HVP= 15mmHg, and PVP= 15mmHg). The third patient, a 74-year-old man with hepatic steatosis and splenomegaly received 70 mg of ketamine and 1 mg of midazolam. EUS-PPG was successful (HVP= 3mmHg, PVP= 3mmHg) yielding a PPG 0mmHg. All patients tolerated the procedure well with no procedural or sedation-related complicationsConclusionsOur early experience suggests that EUS-PPG can be successfully and safely performed in patients under conscious sedation with ketamine and low-dose midazolam. This combination may avoid deep sedation with high dose midazolam or propofol which are known to alter accuracy of HVPG. Measurement of HVP (left) and PVP (right)Funding AgenciesNone

Perivascular epithelioid cell tumor of the falciform ligament with recruitment of the paraumbilical vein

We report a case of a perivascular epithelioid cell tumor occurring in the falciform ligament of an otherwise healthy 32-year-old woman. The mass was hypervascular with central necrosis on computed tomography (CT) and contrast-enhanced ultrasound. Our case is unique as CT and ultrasound revealed a paraumbilical vein arising from the expected location in the fissure for the falciform ligament and terminating in the superior aspect of the mass. The vascular anatomy of a recanalized paraumbilical vein, typically associated with portal hypertension, was complete with drainage of blood from the inferior aspect of the mass through the inferior epigastric veins to the femoral veins. The patient had no evidence of liver disease or portal hypertension.

A midline abdominal incision: can it be that dangerous? A huge umbilical vein in a cirrhotic patient

The umbilical vein transport oxygenated blood from the placenta to the fetus. It travels through the umbilical cord, which disappears at birth. It divides in two, one part going to the liver, the other one flowing into the inferior vena cava through the ductus venosus. During labor, uterine contractions cause an increase in fetal arterial pressure, which results in a decrease in the flow of para umbilical veins. A decrease in intrahepatic blood flow in the case of liver cirrhosis increases resistance in the portal vein, resulting in portal hypertension. In order to combat portal hypertension, portosystemic shunts develop in four directions: superior (left gastric vein), inferior (via hemorrhoidal veins), posterior (left renal vein), and anterior with repermeabilization of the umbilical vein and abdominal wall veins giving Cruveilhier-Baumgarten syndrome. We report the case of a 41-year-old patient followed for a hepatic cirrhosis without obvious etiology classified as child A with portal hypertension responsible for an important splenomegaly and a hypersplenism associated with a repermeabilization of the umbilical vein, operated in our general surgery department at the University Hospital of Tangier, for a non-metastatic neuroendocrine carcinoma of the gastric antrum having benefited from an antrectomy with lymph node dissection. It should be noted that the incision was in the midline above the umbilicus strict and very careful because of the risk of damaging the umbilical vein which was of large caliber and can causing a cataclysmic and uncontrollable hemorrhage. We present the impressive image of the umbilical vein in this patient.

S2622 Cruveilhier- Baumgarten Syndrome

Introduction: Cruveilhier- Baumgarten syndrome CB) is an uncommon condition, the term is used for cases of liver cirrhosis with portal hypertension in which a recanalization of umbilical and paraumbilical veins causes a loud venous hum that can be heard over the abdomen. Case Description/Methods: A 51 year old male with a past medical history of alcohol abuse, alcoholic liver cirrhosis and esophageal varices presented to the emergency room complaining of coffee ground emesis and dark-colored stools. On a physical exam, a small umbilical venous dilatation with a low-pitched continuous hum was noted on auscultation. Abdominal ultrasound demonstrated hepatofugal flow. CT abdomen and pelvis without contrast showed findings consistent with cirrhotic liver, mild ascites, splenomegaly and umbilical vein recanalization. The patient underwent an EGD, which was negative for any esophageal or gastric varices. Discussion: In 1833 Pegot reported a case of portal hypertension in which a loud venous hum was heard at the umbilicus. In 1883, Sappey described accessory portal veins in the suspensory ligament entering the liver capsule through different locations, such as the vessels located at the falciform ligament through which the anterior parietal veins communicate with the left branch of the portal vein. These vessels play an important role in the origin of transhepatic portosystemic shunts. Paraumbilical vessels may anastomose with the superior epigastric or internal thoracic veins and drain into the superior vena cava or anastomose with the inferior epigastric vein and then drain into the IVC through the external iliac vein. In CB syndrome, the umbilical portion of the left portal vein feeds the paraumbilical vein that then leaves the liver and extends toward the umbilicus. Our case describes a patient with liver cirrhosis who was found to have a continuous umbilical venous hum on a physical exam with imaging findings consistent with a recanalized paraumbilical vein. It is hypothesized that the recanalization of the paraumbilical vein in portal hypertension acts to decrease hepatofugal flow, thus becoming a preventative factor in the formation of esophageal varices. Although uncommon, the presence of recanalization of the paraumbilical vein implies a variation in the prognosis in those with decompensated liver cirrhosis, thus, warrants further investigation. We presented a case of CB syndrome, a condition in which a transhepatic portosystemic shunt can prevent the formation of esophageal varices.

Collaterals in portal hypertension: anatomy and clinical relevance.

Portal hypertension is a key pathophysiology of chronic liver diseases typified with cirrhosis or noncirrhotic portal hypertension. The development of collateral vessels is a characteristic feature of impaired portal hemodynamics. The paraumbilical vein (PUV), left gastric vein (LGV), posterior gastric vein (PGV), short gastric vein (SGV), splenorenal shunt (SRS), and inferior mesenteric vein (IMV) are major collaterals, and there are some rare collaterals. The degree and hemodynamics of collateral may affect the portal venous circulation and may compensate for the balance between inflow and outflow volume of the liver. Additionally, the development of collateral shows a relation with the liver function reserve and clinical manifestations such as esophageal varices (EV), gastric varices, rectal varices and the other ectopic varices, hepatic encephalopathy, and prognosis. Furthermore, there may be an interrelationship in the development between different collaterals, showing additional influences on the clinical presentations. Thus, the assessment of collaterals may enhance the understanding of the underlying pathophysiology of the condition of patients with portal hypertension. This review article concluded that each collateral has a specific function depending on the anatomy and hemodynamics and is linked with the relative clinical presentation in patients with portal hypertension. Imaging modalities may be essential for the detection, grading and evaluation of the role of collaterals and may help to understand the pathophysiology of the patient condition. Further investigation in a large-scale study would elucidate the basic and clinical significance of collaterals in patients with portal hypertension and may provide information on how to manage them to improve the prognosis as well as quality of life.

Focal Hepatic Hot Spot Sign

The focal hepatic hot spot sign appears as an area of increased radiopharmaceutical uptake of the quadrate lobe of the liver in the arteial an veinous phase. This sign seen on CT is due to obstruction of the superior vena cava and portosystemic venous shunt between the superior vena cava and the left portal vein via the thoracic and internal para-umbilical veins.

Refined ultrasonographic criteria for sinusoidal obstruction syndrome after hematopoietic stem cell transplantation.

Hepatic sinusoidal obstruction syndrome (SOS)/veno-occlusive disease is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). We previously reported the efficacy of the Hokkaido Ultrasonography (US)-based scoring system (HokUS-10) for US findings. To establish easier-to-use criteria, we retrospectively evaluated US findings from 441 patients, including 30 patients with SOS using the HokUS-10 scoring system. Using logistic regression analysis, we established the novel diagnostic criteria HokUS-6. In the presence of ascites, US diagnosis was made in the presence of two of the following 6 parameters: moderate amount of ascites, the appearance of a paraumbilical vein blood flow signal, gallbladder wall thickening, portal vein dilatation, portal vein velocity decrease, and hepatic artery resistive index increase. The AUC, sensitivity, and specificity of HokUS-6 were 0.974 (95% confidence interval 0.962-0.990), 95.2%, and 96.9%, respectively. The scores were significantly higher in patients with severe SOS than in those with non-severe SOS (p = 0.013). Furthermore, the scores before HSCT were significantly higher in patients who developed SOS than in controls (p = 0.001). The HokUS-6 is an easy and useful way to diagnose and identify the risk of SOS.

Reliability of an ultrasonographical scoring system for diagnosis of sinusoidal obstruction syndrome/veno-occlusive disease in patients with hematopoietic stem cell transplantation.

Sinusoidal obstruction syndrome (SOS)/hepatic veno-occlusive disease (VOD) is a fatal complication after hematopoietic stem cell transplantation. We previously reported the usefulness of an ultrasonographical (US) scoring system, the Hokkaido US-based scoring system consisting of ten parameters (HokUS-10): (1) hepatomegaly in the left lobe and (2) right lobe, (3) dilatation of the main portal vein (PV), (4) hepatofugal flow in the main PV, (5) decreased velocity of the PV, (6) dilatation of the para-umbilical vein (PUV), (7) appearance of blood flow signal in the PUV, (8) gallbladder (GB) wall thickening, (9) ascites, and (10) increased resistive index of the hepatic artery, for the diagnosis of SOS/VOD. However, the reliability of this system among operators remains elusive. Therefore, we prospectively evaluated the reliability of HokUS-10. Twenty-four healthy volunteers and 40 patients with liver dysfunction were enrolled. Inter- and intra-operator reliabilities were analyzed using three sonographers. The median concordance rate of HokUS-10 among three sonographers and intra-operator in 24 volunteers was 92% (95% CI: 73-98%) and 98% (95% CI: 92-100%), respectively. In all 64 cases, in terms of the reliability between two sonographers for three representative US parameters (amount of ascites, GB wall thickening, and appearance of PUV blood flow signal), the median concordance rate was more than 98% (95% CI: 86-106%). The inter- and intra-reliabilities of HokUS-10 were excellent. Thus, US might be a reliable tool for SOS/VOD diagnosis.

Cyanoacrylate injection complications: septic emboli and abscess within the falciform ligament - a case report

Background: Falciform ligament abscesses are uncommon. The few cases reported in the literature are associated with infectious or inflammatory conditions such as acute cholecystitis and omphalitis in pediatric patients. However, it has only been rarely described as a complication for some therapeutic procedures. Case Presentation: A 23-year-old female with primary portal vein thrombosis, portal hypertension, and gastric varices with a history of upper gastrointestinal bleedings. The last episode required cyanoacrylate injection. After administering the injection, septic emboli obstructed the splenic vein causing the recanalization and thrombosis of the paraumbilical veins. Therefore, an abscess formed within the falciform ligament. The treatment consisted of surgical drainage and antibiotics. Conclusion: Diagnosis of falciform ligament abscesses requires a high degree of clinical suspicion and vast knowledge of anatomy. It is important to recognize its pathophysiology and consider the possible differential diagnosis to offer the best approach and treatment for its underlying cause.

Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

We describe treatment of a 53-year-old man with chronic hepatic encephalopathy. Contrast-enhanced computed tomography demonstrated a recanalized paraumbilical vein as a portosystemic shunt connecting the left branch of the portal vein and bilateral iliac veins. Percutaneous embolization was performed. The paraumbilical vein was punctured under ultrasonographic guidance; a 7-Fr sheath was inserted in the cranial direction. The hepatic side of the shunt was embolized with a vascular plug. The sheath direction was inverted to the caudal side; the pelvic side of the shunt was then embolized with another vascular plug. This report demonstrates that the percutaneous transparaumbilical venous approach is useful and safe for portosystemic shunt intervention. Moreover, the one-sheath inverse method was useful for embolization of upstream and downstream sides of the puncture site.

Can the Computed Tomographic Aspect of Porto-Systemic Circulation in Cirrhotic Patients be Associated with the Presence of Variceal Hemorrhage?

Background and objectives: Variceal bleeding is a serious complication caused by portal hypertension, frequently encountered among cirrhotic patients. The purpose of this study was to determine whether the aspect of the collateral, porto-systemic circulation, as detected by CT are associated with the presence variceal hemorrhage (VH). Materials and Methods: 81 cirrhotic patients who underwent a contrast-enhanced CT examination were retrospectively included in the study. Patients were divided into two groups: Cirrhotic patients with variceal hemorrhage during the hospital admission concomitant, with the CT examination (n = 33) and group 2-cirrhotic patients, without any variceal hemorrhage in their medical history (n = 48). The diameter of the left gastric vein, the presence or absence and dimensions of oesophageal and gastric varices, paraumbilical veins and splenorenal shunts were the indicators assessed on CT. Results: The univariate analysis showed a significant association between the presence of upper GI bleeding and the diameters of paraoesophageal veins, paragastric veins and left gastric vein respectively, all of these CT parameters being higher in patients with variceal bleeding. In the multivariate logistic regression analysis, only the diameter of the left gastric vein was independently associated with the presence of variceal hemorrhage (OR = 1.6 (95% CI: 1.17–2.19), p = 0.003). We found an optimal cut-off value of 3 mm for the diameter of the left gastric vein useful to discriminate among patients with variceal hemorrhage from the ones without it, with a good diagnostic performance (AUC = 0.78, Se = 97%, Sp = 45.8%, PPV = 55.2%, NPV = 95.7%). Conclusions: Our observations point out that an objective CT quantification of porto-systemic circulation can be correlated with the presence of variceal hemorrhage and the diameter of the left gastric vein can be a reliable parameter associated with this condition.