Portal venous system thrombosis

Case contributed by Dr Mostafa Mahmoud El-Feky

Presentation

Abdominal pain and vomiting

Patient Data

Age: 30 years
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 with mild enhancement of portal venous wall. 

The superior mesenteric and inferior mesenteric veins, as well as their branches, are completely thrombosed (mesenteric venous occlusion).

The spleen is markedly enlarged (measuring 22 cm in bipolar diameter - coronal plane) 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 hyperdense. The diagnosis is made on the portal venous phase of contrast-enhanced studies.

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Case information

rID: 52263
Published: 31st Mar 2017
Last edited: 23rd Mar 2019
Inclusion in quiz mode: Included

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