Presentation
Pyrexia and abdominal pain. ? Cause. CRP 310 WBC 24 LFTs: Bilirubin 49 ALT 35 ALP 229
Patient Data
The portal vein is swollen with no contrast seen within, compatible with portal vein thrombosis.
An ill-defined swelling in the liver around the intrahepatic portal vein branches, consistent with 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 deranged liver function tests.
The CT study revealed portal vein thrombosis, 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 caliber.
Pylephlebitis of the portal vein is an acute ascending infection. It is often secondary to an abdominal infection, such as appendicitis or diverticulitis.
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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