E5434. Tangled Bleeding Web: A Case-Based Review of Abdominal Vascular Pathologies
  1. Chang Shu; University of California, Irvine School of Medicine
  2. Danielle Amato; University of California, Irvine School of Medicine
  3. Erwin Ho; University of California, Irvine School of Medicine
  4. Sungmee Park; University of California, Irvine School of Medicine
  5. Alexander Ushinsky; Mallinckrodt Institute of Radiology; University of California, Irvine School of Medicine
  6. Roozbeh Houshyar; University of California, Irvine School of Medicine
  7. James Shi; University of California, Irvine School of Medicine
Rare vascular diseases often present diagnostic challenges due to their diverse clinical manifestations. The ability to recognize these unique clinical features and initiate appropriate diagnostic workup is crucial. This educational exhibit adopts a case-based approach to explore various vascular pathological conditions encountered in abdominal imaging including pelvic congestion syndrome (PCS) and hereditary hemorrhagic telangiectasia (HHT). Our aim is to equip radiologists, trainees, and clinicians with the knowledge to confidently diagnose and manage these rare vascular pathological conditions, ultimately enhancing patient care.

Educational Goals / Teaching Points
By the end of this presentation, readers will gain a general understanding of uncommon vascular pathologies. Each case will provide a clinical presentation, a description of the image findings, and a review of the diagnosis and pathophysiology. Furthermore, readers will develop an awareness of relevant demographic information, key imaging findings, and indications that will aid in the diagnosis and management of these conditions. Concurrently, it is vital for diagnostic and interventional radiologists to be cognizant of current efficacious interventional therapies for managing these conditions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
PCS is a common cause of chronic pelvic pain in women. Risk factors of PCS include multiparity, premenopausal age, and a family history of pelvic pain. Although its etiology remains elusive, the pathogenesis of PCS involves the insufficient venous draining of the uterine plexus. The resultant venous dilation causes pain through the release of inflammatory cytokines. PCS clinical manifestations include chronic, dull unilateral or bilateral pelvic pain, dyspareunia, and superficial varicose veins. Complications include infertility and can extend to result in leg pain and ulceration. The key to an accurate PCS diagnosis is the combination of PVI with chronic pelvic pain. Lastly, proper PCS management involves interventional therapies such as coil embolization of the ovarian vein or embolization with glue and lipiodized oil. HHT is a rare autosomal dominant disorder that manifests with many clinical features including cutaneous telangiectasias, epistaxis, gastrointestinal bleeding, and visceral organ arteriovenous malformations (AVM). Because presentations can vary drastically, early clinical recognition and diagnosis is important to begin appropriate screening and treatment for visceral organ AVMs to prevent debilitating sequalae. Complications of AVMs include portal hypertension, high output cardiac failure, hemoptysis, hemorrhage, stroke, and brain abscesses. At least three of the Curaçao Criteria must be present for a definite HHT diagnosis. Finally, management of HHT benefits from transarterial embolization or surgical ligation to treat specific symptoms.

Understanding the risk factors and key diagnostic features will prepare clinicians to manage uncommon vascular pathological conditions. Accurate and timely diagnosis combined with proper interventional therapies will result in improved clinical outcomes and patient care.