Portal venous system thrombosis

Case contributed by Moamer Abdulghafoor Ibrahim
Diagnosis certain


Abdominal pain

Patient Data

Age: 55 years
Gender: Female

CT of the abdomen shows filling defect involving the inferior mesenteric vein, superior mesenteric vein, splenic vein and portal vein. Mesentery looks misty around the superior mesenteric vein. The spleen is enlarged and shows wedge shaped hypodense hypoenhancing area suggesting splenic infarction.

Case Discussion

Portal venous system thrombosis can occur in the setting of hypercoagulable states like solid or hematological malignancies. It can occur in ladies on combined contraceptive pills and it can occur as a complication in cases with intra-abdominal inflammation and infection like appendicitis, diverticulitis and pancreatitis.

In this case, the patient was suspected to have hematological malignancy because lab results showed anemia and high erythrocyte sedimentation rate. Few small lytic bone lesions were appreciated in the axial skeleton and myeloproliferative disorder was suggested as a cause of portal venous thrombosis.

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