Pylephlebitis / septic thrombophlebitis

Case contributed by Dr Nolan Walker

Presentation

Abdominal pain. Pyrexia. ? Cause. CRP 310 WBC 24 LFTs: Bilirubin 49 ALT 35 ALP 229

Patient Data

Age: 45 years old
Gender: Male

The portal vein itself is swollen with no contrast seen within, consistent with portal vein thrombosis.

In addition there is ill-defined swelling in the liver around the intra-hepatic portal vein branches. Indicating inflammation.

There is no intrahepatic biliary duct dilatation.

No other abnormality detected throughout the abdomen or pelvis.

Case Discussion

This patient was admitted septic with raised inflammatory markers and mildly derranged liver function tests.

The CT study revealed there to be thrombus in the portal vein consistent with portal vein thrombus, in conjunction with ill-defined peri-portal vein swelling throughout the liver which is suggestive of inflammation.

The remainder of the abdominal viscera are normal. In view of the portal vein thrombus, raised inflammatory markers, sepsis and CT signs of peri-portal vein inflammation, a diagnosis of pylephlebitis was made.

MRCP and ERCP were both normal, in particular the CBD was of normal calibre.

Pylephlebitis of the portal vein is an acute ascending infection. It is often secondary to abdominal infection, such as appendicitis or diverticulitis.

The imaging findings are that of intra-hepatic peri-portal vein ill-defined low attenuation, as seen in this case, illustrating inflammation, in conjunction with portal vein thrombus.

No cause for the pylephlebitis was identified in this patient.

 

Presented with Dr. Ben Warner MD BSc MRCP, Clinical Fellow in Gastroenterology, Guy's and St Thomas' NHS Foundation Trust. 

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Case information

rID: 44251
Case created: 13th Apr 2016
Last edited: 30th Aug 2016
Inclusion in quiz mode: Included

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