OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.233 |
Resumo: | Introduction: Diagnosis of chronic iliac venous outflow obstruction is challenging, and no ideal imaging method has yet been defined. Even with imaging with superb detail, common iliac vein disappearance as occurs in Post-Thrombotic Syndrome (PTS) may be missed even by the most experienced radiologist. This scanning error occurs due to psychophysiological factors of human visual perception. The purpose of this paper is to report on the “obturator hook sign”, evidencing obturator vein engorgement as a collateral pathway and hence a marker for hemodynamically significant chronic iliac venous outflow lesion, supporting this diagnosis. Methods: Retrospective review of Indirect and Direct Computed Tomography Venography (CTV) and Magnetic Resonance Venography (MRV) imaging of the obturator hook sign and comprehensive literature review regarding iliac vein outflow obstruction diagnosis focusing on collateral vein development. Results : The obturator hook sign is identified in Direct CTV, Indirect CTV and MRV of patients with chronic iliac venous outflow obstruction. The sign was never identified in imaging studies with no chronic iliac obstruction, suggesting high specificity. Discussion: Venous collateralization is poorly understood, but it has been shown that when the main venous path is stenosed or occluded and the venous pressure rises, flow is side-tracked through alternative pathways. When the main venous path lesion is stented, flow once again takes the lower resistance pathway and the collaterals withdraw. The obturator hook sign can be easily recognisable in CTV and MRV due to its peculiar anatomy and immediately points us towards hemodynamically significant chronic iliac venous outflow obstruction. |
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OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTIONSINAL DO GANCHO DO OBTURADOR — QUANDO A VEIA ILIACA COMUM DESAPARECE E NÃO VEMOSComputed Tomography Angiography [MeSH]Postthrombotic Syndrome [MeSH]Diagnosis, Differential [MeSH]May-Thurner Syndrome [MeSH];Angiotomografia ComputorizadaSíndrome Pós-TrombóticoDiagnóstico DiferencialSíndrome de May-ThurnerIntroduction: Diagnosis of chronic iliac venous outflow obstruction is challenging, and no ideal imaging method has yet been defined. Even with imaging with superb detail, common iliac vein disappearance as occurs in Post-Thrombotic Syndrome (PTS) may be missed even by the most experienced radiologist. This scanning error occurs due to psychophysiological factors of human visual perception. The purpose of this paper is to report on the “obturator hook sign”, evidencing obturator vein engorgement as a collateral pathway and hence a marker for hemodynamically significant chronic iliac venous outflow lesion, supporting this diagnosis. Methods: Retrospective review of Indirect and Direct Computed Tomography Venography (CTV) and Magnetic Resonance Venography (MRV) imaging of the obturator hook sign and comprehensive literature review regarding iliac vein outflow obstruction diagnosis focusing on collateral vein development. Results : The obturator hook sign is identified in Direct CTV, Indirect CTV and MRV of patients with chronic iliac venous outflow obstruction. The sign was never identified in imaging studies with no chronic iliac obstruction, suggesting high specificity. Discussion: Venous collateralization is poorly understood, but it has been shown that when the main venous path is stenosed or occluded and the venous pressure rises, flow is side-tracked through alternative pathways. When the main venous path lesion is stented, flow once again takes the lower resistance pathway and the collaterals withdraw. The obturator hook sign can be easily recognisable in CTV and MRV due to its peculiar anatomy and immediately points us towards hemodynamically significant chronic iliac venous outflow obstruction.Introdução: O diagnóstico de obstrução crónica do efluxo venoso ilíaco é desafiante e não existe nenhum método de imagem ideal. Mesmo com elevada qualidade de imagem a ausência súbita da veia ilíaca comum tal como ocorre na Síndrome Pós-Trombótico (SPT), pode ser subvalorizado mesmo por radiologistas experientes. Este erro de scanning ocorre devido a fatores psicofisiológicos da perceção visual humana. O objetivo deste trabalho é relatar o “sinal do gancho do obturador”, demonstrando o aumento do calibre da veia obturadora como uma via colateral e, portanto, um marcador de lesão crónica hemodinamicamente significativa do efluxo venoso ilíaco. Métodos: Estudo retrospetivo de imagens de venografia por tomografia computadorizada indireta e direta (VTC) e veno- grafia por ressonância magnética (RMN) do sinal do obturador e revisão compreensiva da literatura relativa a diagnostico de obstrução do efluxo venoso ilíaco com enfâse nos mecanismos de desenvolvimento de colateralidade. Resultados: O sinal do gancho do obturador é identificado em VTC e RMN de doentes com obstrução crónica do efluxo venoso ilíaco. O sinal não foi identificado em nenhum estudo imagiológico que não apresentasse concomitantemente obstrução do efluxo venoso, sugerindo tratar-se de um sinal com elevada especificidade. Discussão: A colateralização venosa é um tema complexo, mas já foi demonstrado que, quando o trajeto venoso principal tem uma lesão hemodinamicamente significativa e a pressão venosa aumenta, o fluxo é desviado através de vias alternativas. Por outro lado, quando a lesão do trajeto venoso principal é tratada, o fluxo venoso regressa ao trajeto de menor resistência e as colaterais desaparecem. O sinal do gancho do obturador pode ser facilmente reconhecido em VTC e RMN devido à sua anatomia particular e aponta imediatamente para a obstrução do fluxo venoso ilíaco hemodinamicamente significativo.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2019-12-27T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.233oai:ojs.acvjournal.com:article/233Angiologia e Cirurgia Vascular; Vol. 15 No. 3 (2019): September; 196-199Angiologia e Cirurgia Vascular; Vol. 15 N.º 3 (2019): Setembro; 196-1992183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/233https://doi.org/10.48750/acv.233http://acvjournal.com/index.php/acv/article/view/233/150Copyright (c) 2019 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCoelho, AndreiaO'Sullivan, Gerard2022-05-23T15:10:06Zoai:ojs.acvjournal.com:article/233Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:36.668033Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION SINAL DO GANCHO DO OBTURADOR — QUANDO A VEIA ILIACA COMUM DESAPARECE E NÃO VEMOS |
title |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION |
spellingShingle |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION Coelho, Andreia Computed Tomography Angiography [MeSH] Postthrombotic Syndrome [MeSH] Diagnosis, Differential [MeSH] May-Thurner Syndrome [MeSH]; Angiotomografia Computorizada Síndrome Pós-Trombótico Diagnóstico Diferencial Síndrome de May-Thurner |
title_short |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION |
title_full |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION |
title_fullStr |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION |
title_full_unstemmed |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION |
title_sort |
OBTURATOR HOOK SIGN — WHEN THE COMMON ILIAC VEIN DISAPPEARANCE ELUDES VISUAL DETECTION |
author |
Coelho, Andreia |
author_facet |
Coelho, Andreia O'Sullivan, Gerard |
author_role |
author |
author2 |
O'Sullivan, Gerard |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Coelho, Andreia O'Sullivan, Gerard |
dc.subject.por.fl_str_mv |
Computed Tomography Angiography [MeSH] Postthrombotic Syndrome [MeSH] Diagnosis, Differential [MeSH] May-Thurner Syndrome [MeSH]; Angiotomografia Computorizada Síndrome Pós-Trombótico Diagnóstico Diferencial Síndrome de May-Thurner |
topic |
Computed Tomography Angiography [MeSH] Postthrombotic Syndrome [MeSH] Diagnosis, Differential [MeSH] May-Thurner Syndrome [MeSH]; Angiotomografia Computorizada Síndrome Pós-Trombótico Diagnóstico Diferencial Síndrome de May-Thurner |
description |
Introduction: Diagnosis of chronic iliac venous outflow obstruction is challenging, and no ideal imaging method has yet been defined. Even with imaging with superb detail, common iliac vein disappearance as occurs in Post-Thrombotic Syndrome (PTS) may be missed even by the most experienced radiologist. This scanning error occurs due to psychophysiological factors of human visual perception. The purpose of this paper is to report on the “obturator hook sign”, evidencing obturator vein engorgement as a collateral pathway and hence a marker for hemodynamically significant chronic iliac venous outflow lesion, supporting this diagnosis. Methods: Retrospective review of Indirect and Direct Computed Tomography Venography (CTV) and Magnetic Resonance Venography (MRV) imaging of the obturator hook sign and comprehensive literature review regarding iliac vein outflow obstruction diagnosis focusing on collateral vein development. Results : The obturator hook sign is identified in Direct CTV, Indirect CTV and MRV of patients with chronic iliac venous outflow obstruction. The sign was never identified in imaging studies with no chronic iliac obstruction, suggesting high specificity. Discussion: Venous collateralization is poorly understood, but it has been shown that when the main venous path is stenosed or occluded and the venous pressure rises, flow is side-tracked through alternative pathways. When the main venous path lesion is stented, flow once again takes the lower resistance pathway and the collaterals withdraw. The obturator hook sign can be easily recognisable in CTV and MRV due to its peculiar anatomy and immediately points us towards hemodynamically significant chronic iliac venous outflow obstruction. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-12-27T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.233 oai:ojs.acvjournal.com:article/233 |
url |
https://doi.org/10.48750/acv.233 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/233 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/233 https://doi.org/10.48750/acv.233 http://acvjournal.com/index.php/acv/article/view/233/150 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2019 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2019 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 15 No. 3 (2019): September; 196-199 Angiologia e Cirurgia Vascular; Vol. 15 N.º 3 (2019): Setembro; 196-199 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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