Presentation
Referred by GP with RUQ pain, AKI, deranged LFTs, CRP 140. External US showed thrombus left branch portal vein. CT to further assess ?thrombus ?mass
Patient Data
Nonocclusive thrombus is demonstrated in the left portal vein. No significant biliary dilatation. No focal abnormality in the liver.
In the proximal to mid sigmoid colon, there is a 3 cm lesion with slightly shouldered margins, narrowing the lumen, without evidence of obstruction. Arising from this lesion is a 3 cm extraluminal mass extending along the associated segment of sigmoid mesocolon. Small para-aortic lymph nodes are present.
Subcentimeter nodule adjacent to the descending colon (best seen on coronal images) is probably extraluminal, likely a peritoneal nodule.
No peritoneal free fluid or free gas. Right adrenal 13 mm nodule is indeterminate.
Conclusion:
1. Left portal vein thrombus, with no focal lesion in the liver.
2. Sigmoid colon mass is concerning for a primary colonic malignancy, with associated local extraluminal extension.
3. Suspected peritoneal metastasis.
4. Indeterminate right adrenal 13 mm nodule, with adrenal CT suggested to further evaluate if clinically warranted.
Case Discussion
Prothrombotic states can occur as a result of malignancy.
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