Septic thrombophlebitis of the intrahepatic portal vein

Case contributed by Dr Michael P Hartung

Presentation

Fever and sepsis. Evaluate for source of infection.

Patient Data

Age: 65 years
Gender: Male

Heterogeneous hypoperfusion of hepatic segment 6. Somewhat linear, low-attenuation branching structures in segment 6, following expected distribution of portal vein. Main portal vein and remainder of intrahepatic portal venous branches are patent. 

No other intraabdominal source of infection identified. 

Case Discussion

Septic thrombophlebitis of the portal vein most often occurs as a complication of intraabdominal infection such as diverticulitis and appendicitis. It can also be an isolated finding, as in this case.

Diminished perfusion of segment 6 should prompt further investigation. Note the low-attenuation branching structures (that are NOT the unopacified hepatic veins). Also notice that the remainder of the intrahepatic portal venous segments are patent, making this diagnosis basically certain. 

Suggesting this diagnosis can direct antibiotic and (when appropriate) anticoagulation therapy. 

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Case information

rID: 60829
Published: 4th Jun 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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