Venous Thrombosis and Hypercoagulability in the Abdomen and Pelvis

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.50
Procedures: 2.50
Abdomen and Pelvis: 2.50

Magnetic Resonance Imaging: 2.50
Procedures: 2.50
Body: 2.50

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Neurological, Vascular, and Lymphatic Sections: 3.00

Sonography: 2.50
Procedures: 2.50
Abdomen: 2.50

Radiation Therapy: 1.00
Procedures: 1.00
Treatment Sites and Tumors: 1.00

Vascular-Interventional Radiography: 1.00
Procedures: 1.00
Vascular Diagnostic Procedures: 1.00

Vascular Sonography: 2.50
Procedures: 2.50
Abdominal/Pelvic Vasculature: 2.50

Outline

1. Introduction
2. Pathophysiology of Venous Thrombus
3. Multimodality Imaging Findings of Thrombus
4. Causes of Thrombosis
   1. Malignancy
      1. Renal Cell Carcinoma
      2. Hepatocellular Carcinoma
      3. Adrenal Cortical Carcinoma
      4. Neuroendocrine Tumors
      5. Trousseau Syndroma
   2. Prothrombotic Events
      1. Postprocedural Complications
      2. Immobility
   3. Infectious Conditions
      1. Lemierre Syndrome
      2. Pylephlebitis
   4. Anatomic Conditions
      1. May-Thurner Syndrome
   5. Genetic Conditions
      1. Factor V Leiden Mutation
      2. Antithrombin, Protein C, and Protein S Deficiencies
      3. JAK2 Gene Mutations
      4. Paroxysmal Nocturnal Hemoglominuria
   6. Miscellaneous Conditions
      1. Budd-Chiari Syndrome
      2. Portal Vein Thrombosis
   7. Pitfalls: Slow Flow
5. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with imaging modalities used for evaluation of vascular structures
2. be familiar with the 30-day mortality rates associated with PE
3. be familiar with the Virchow triad
4. identify the carcinomas associated with direct tumor invasion into the vasculature
5. be familiar with risk factors for VTE
6. identify the modality of choice for evaluation of venous thrombosis in the extremities
7. recognize the limitation for US for diagnosis of DVT
8. recognize the hallmark feature of acute thrombus on CT
9. identify the viable means of assessing lower extremity vascularization in patients whom US may not be practical
10. identify an accurate alternative to CT pulmonary angiography for detection of PE
11. be familiar with the significance of a clot on staging, prognosis, and treatment of a tumor
12. be familiar with the frequency of renal cell carcinoma
13. be familiar with the characteristics of a tumor thrombus on CT and MRI
14. be familiar with management strategies for the patient with tumor thrombus
15. be familiar with the occurrence of adrenal cortical carcinoma
16. be familiar with the syndrome caused by adrenal cortical carcinoma
17. be familiar with the classifications for pancreatic neuroendocrine tumors
18. be familiar with the definition Trousseau syndrome
19. identify the technical issues occurring during transplantation
20. identify the common causes for transient immobility
21. understand the VTE risks associated with orthopedic surgery
22. be familiar with Lemierre syndrome
23. identify the diagnostic modality of choice for imaging patients with Lemierre syndrome
24. be familiar with the causes for pylephlebitis
25. recognize the organisms associated with pylephlebitis
26. be familiar with the treatments for patients suffering with pylephlebitis
27. be familiar with May-Thurner syndrome
28. identify the reference standard for diagnosis of May-Thurner syndrome
29. be familiar with the pathologic basis for factor V Leiden mutation
30. identify which patient population is most associated with factor V Leiden mutation
31. be familiar with the environmental factors increasing risk of thrombosis in factor V Leiden patients
32. recognize the deficiencies associated with inherited thrombophilia
33. be familiar with frequency of thrombotic events due to protein C and protein S deficiencies
34. be familiar with the gene associated with common causes of splanchnic vein thromboses
35. be familiar with the first manifestation for unexplained splanchnic vein thrombosis
36. identify the imaging modality of choice for patients with paroxysmal nocturnal hemoglobinuria (PNH)
37. be familiar with Budd-Chiari syndrome
38. identify the common risk factors for the development of portal vein thrombosis
39. be familiar with a CT artifact that masquerades as a thrombosis
40. be familiar with an MRI artifact that can create misallocation in the images