Presentation
Known pancreatic cancer with liver metastasis. For restaging.
Patient Data
Age: 60 years
Gender: Female
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47 mm low attenuation mass centered on the pancreatic tail, with infiltration of the left adrenal gland and the celiac axis.
Associated splenic vein occlusion.
There is evidence of segmental portal hypertension with gastric varices.
No features to suggest background chronic liver disease.
No splenomegaly. No free fluid.
Case Discussion
Sinistral (or segmental) portal hypertension occurs as a result of splenic vein occlusion, most commonly secondary to pancreatic pathology (pancreatitis, pseudocyst or carcinoma).
The most common features include esophageal or gastric varices, which can bleed acutely.
Concurrent systemic portal hypertension should be excluded.
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