Presentation
Abdominal pain, recently COVID+.
Patient Data
Thrombosis of the superior mesenteric vein and central branches with mild mesenteric edema. The uterus is relatively enlarged.
Case Discussion
SMV thrombosis can be an unexpected finding (as in this case), which highlights a few key learning points:
SMV thrombosis can be easy to overlook when the vein is uniformly unopacified (as in this case) - e.g. sometimes in radiology, it is hard to see what's not there but should be, particularly when dealing with thrombosed vessels.
thus looking for secondary signs that raise suspicion of thrombosis is key - mesenteric stranding, bowel wall thickening or congestion, fluid, and hypoenhancement
this also emphasizes the importance of a consistent search pattern where you run the portal, splenic, and superior mesenteric veins; notice how it is easier to detect the thrombosis on coronal reformats as you can see longer segments of the veins, with the SMV clot leading to the confluence
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