Cavernous transformation of the portal vein

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Known cirrhosis, now leg swelling.

Patient Data

Age: 80 years
Gender: Female

Typical features of cirrhosis and portal hypertension including small irregular liver, marked splenomegaly, ascites and enlarged mesenteric veins. Gallstones are also noted.

Note also, the enlarged thrombosed portal vein with multiple venous collaterals in the porta hepatis indicative of so-called cavernous transformation. 

Case Discussion

Cavernous transformation of the portal vein refers to numerous vascular structures in the region of the portal vein, which enhance during the portal venous phase.

Leg swelling, in this case, is due to para-aortic lymphadenopathy (lymphoma) compressing the inferior vena cava. 

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