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SOS/VOD diagnosis is often difficult. It relies on biological parameters (bilirubin increase ≥ 2mg/dL or 34.2µmol/L) and clinical evaluation (sodium fluid retention with weight gain > 5%, ascites, painful hepatomegaly) (M. Mohty and al. Revised criteria for SOS/VOD, BMT (2016) 906-912). Quick symptoms apparition, quick presence of severity criteria sometimes and differential diagnosis (cholestasis secondary to sepsis, fungal infection, viral hepatitis, drug toxicity, haemolysis or microangiopathy, Budd chiari, hyperacute GvHD, right cardiac failure) make it a challenge on the diagnosis perspective while a delay in the management might be catastrophic for the prognosis of patients. In that context, hepatic doppler-ultrasonography is a non-invasive and affordable technique that allows the investigation of hepatic parenchyma in order to detect a pathologic state. In practice, doppler ultrasonography, is helpful to detect hepatomegaly and ascites but also is an help to explore well defined criteria of SOS/VOD already published. For sonography criteria: hepatomegaly (3 measures) with an increase of 2cm versus baseline, gallbladder wall thickening, ascites or 3 criteria of a native VOD; splenomegaly, increase of the portal vein diameter, decrease of the hepatic vein diameter, visualisation of the para umbilical vein and for the doppler : increase of the hepatic artery RI (>0.75), monophasic flow in the hepatic veins (venous retraction is very typical but very late), flow demodulation on portal vein, decrease in portal flow, portal flow congestion, reversed flow, flow recorded in the para-umbilical vein ; all five last signs are late (Lassau N and al Prognostic value of doppler ultrasonography in hepatic veno occlusive disease transplantation 2002 jul 15 ;74(1) :60-6). These criteria can confirm the diagnosis : 6 signs of wich the first 3 can affirm the diagnosis with certainty in combination with clinical and biological parameters.
This exam is much of help in diagnosis and may allow the initiation of treatment. In addition, many patients presenting hepatic risk factors have to be early monitored due to the risk of SOS/VOD and this examination is useful for early detection. More, it is also possible with new generation of sonographic machines to explore hepatic resistance by elastography in order to detect hepatic steatosis or associated fibrosis. There is still few data on this topic especially for allogeneic HSCT patients in particular in whom that develop SOS/VOD. It is also very important to monitor patients with hepatic doppler ultrasonography after allogeneic HSCT as they might develop nodules, tumefaction or hepatic steatosis. It is often necessary to practice hepatic biopsy to ensure diagnosis especially in presence of hepatic cytolysis in order to set adequate management and treatment.
no Particular Condition
Central Hospital, Nancy, France
Published on BioPortfolio: 2019-10-31T14:29:36-0400
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