Portal venous system thrombosis

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Abdominal pain and vomiting

Patient Data

Age: 30
Gender: Female
CT

Triphasic liver CT

The liver is mildly enlarged, with multiple geographic mainly right lobe hypodense non-enhancing patches (perfusion difference).

The portal vein (with its right and left main branches) and splenic vein are distended with luminal thrombosis. The superior mesenteric vein and the inferior mesenteric vein as well as their branches are completely thrombosed (mesenteric vascular occlusion).

The spleen is markedly enlarged (measuring 22 cm) showing multiple wedge shaped non enhanced areas representing splenic infarcts

Case Discussion

The portal venous system consists of the mesenteric, splenic and portal veins. Occlusion of portal veins causes congestion of liver, spleen and bowel loops due to increased venous pressure and the development of venous collaterals. Acute thrombosis may be difficult to detect in non-contrast basis as the thrombus may be iso or hypodense and not usually be hypedense. The diagnosis is made on portal venous phase contrast enhanced studies.

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Case information

rID: 52263
Case created: 30th Mar 2017
Last edited: 3rd Apr 2017
Inclusion in quiz mode: Included

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