Presentation
Chronic recurrent pancreatitis with liver abscesses, and markedly elevated CRP. Phyiscal exam suggestive of ascites.
Patient Data
Age: 60 years
Gender: Male
From the case:
Cavernous transformation of the portal vein
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- multiple complex fluid-filled cystic abnormalities in the liver suggestive of abscesses
- significant amount of free fluid in the pelvis, septated complex free fluid adjacent to the liver
- portal vein can not be identified, instead meandering venous branches are visible in the porta hepatis, indicating portal vein thrombosis and consequent cavernous transformation
From the case:
Cavernous transformation of the portal vein
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Info
The cavernous transformation can be better appreciated in the cine loop.
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CT provided for explanation:
- significant amount of intraperitoneal free fluid
- multiple cystic lesions in the liver containing relatively low density fluid - most likely represent abscesses
- portal vein is occluded, cavernous portal transformation is striking. Well-developed collateral veins
- inhomogenous, atrophied pancreas with surrounding diffuse fat stranding representing chronic pancreatitis, marked dilation of the pancreatic duct
- hypodense gastric antral and duodenal wall, possibly due to inflammation
- other unrelated findings: gallstone, chronic kidney disease, bilateral adrenal hyperplasia
Case Discussion
Typical presentation of chronic portal vein thrombosis with cavernous transformation of the porta hepatis that developed as a complication of chronic pancreatitis. This pathology has a striking, characteristic appearance on ultrasound, but can be easily missed if color Doppler is not applied. In a similar scenario, the presence of a newly developed ascites is an alarming feature that warrants careful scrutiny of the portal venous flow.
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