RADIOGRAPHIC FEATURES OF VENO-OCCLUSIVE DISEASE: WHAT SIGNS SHOULD WE BE LOOKING FOR IN CHILDREN?
By Quynh Tran Great Ormond Street Hospital for Children
Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS) is a complication which can occur after myeloablative hematopoietic stem cell transplantation (HSCT). In children it can also occur after conventional radiotherapy and high dose chemotherapy. The incidence is in approximately 20% of children, however, it can rise up to 60% in patients with specific conditions such as infantile osteoporosis1.
Although in most patients VOD may resolve itself within a few weeks, it remains potentially life threatening with approximately 30-60% of affected children developing multi-organ dysfunction or failure1.
The typical presentation includes hepatomegaly, jaundice and ascites however symptoms can range and the clinical presentation can be self-limiting2. Ultrasound can aid in early diagnosis, allowing for the initiation of treatment sooner in the patient’s clinical course.
This poster aims to educate on VOD and demonstrate the sonographic appearances which can help diagnose VOD, including definitions and examples of periportal oedema, gallbladder wall oedema, hepatic vein narrowing, portal vein dilatation, typical doppler waveforms of the portal vein and hepatic artery. We will also discuss the expected evolution of sonographic features during the patient’s clinical course, and explore the current role of novel techniques, such as elastography and contrast enhanced ultrasound.
References:
1. Corbacioglu S, Carreras E, Ansari M, et al. Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients: a new classification from the European society for blood and marrow transplantation. Bone Marrow Transplant. 2018;53:138–145. doi: 10.1038/bmt.2017.161.
2. Bohte A, Dierselhuis M, Van Noesel M, Lequin M. Imaging features of hepatic sinusoidal obstruction syndrome or veno-occlusive disease in children. Paediatric Radiology. 2022; 52(1): 122-133. doi: 10.1007/s00247-021-05174-w