Pylephlebitis

Pylephlebitis, also known as ascending septic thrombophlebitis, is a thrombotic occlusion of the portal vein or its branches secondary to infection in regions that drain to the portal venous system

Clinical presentation is often vague. Patients may initially present with non-specific abdominal pain, nausea and sepsis in the context of an intra-abdominal infection. Sequelae from hepatic involvement such as jaundice or hepatomegaly may occur in advanced stages. 

Thrombosis of the portal circulation rapidly leads to bowel ischemia, necrosis and perforation. 

Findings on color duplex sonography include flow defect and dilation or absent compressibility of the portal venous system 3.

CT is the modality of choice as it may also detect an underlying cause as well as complications such as bowel ischemia or abscess formation. The finding of an endoluminal thrombus causing a filling defect in contrast filled mesenteric veins is diagnostic 3.

Medical management with antibiotics and anticoagulation is the mainstay of therapy. 

Mortality with early treatment remains as high as 25% 2.

Pylephlebitis was initially described by Waller in 1954 as a cause of hepatic abscess found during autopsy 1.

Share article

Article information

rID: 16036
Tag: stub, cases, refs
Synonyms or Alternate Spellings:
  • ascending septic thrombophlebitis
  • ascending suppurative thrombophlebitis
  • pylephlebitis

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1: secondary to chronic appendicitis
    Drag here to reorder.
  • Pylephlebitis / septic thrombophlebitis
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.