Missed our latest free live-stream? Catch up now with Intracranial Enhancement by Frank Gaillard

Splenic vein thrombosis

Case contributed by Dr Naim Qaqish

Presentation

Epigastric pain, and tenderness on clinical examination.

Patient Data

Age: 40 years
Gender: Female
Ultrasound

The splenic vein appears dilated with intraluminal echogenic material and absent signal on color Doppler consistent with its thrombosis. The thrombosis extends from the splenic hilum till the confluence with the portal vein.

Splenic vein diameter is 1.8 cm.

The portal vein also appears prominent in size measuring about 15 mm, however, it shows normal hepato-petal blood flow. 

Normal blood flow in the superior mesenteric artery (SMA). Hepatic veins, IVC and Aorta are patent on color doppler examination. (Pictures not included).

CT

The splenic vein appears dilated and filled with hypodense material without evidence of contrast enhancement consistent with its thrombosis.

The spleen appears congested with a small amount of fluid in the anterior pararenal space.

The posterior branch of the right portal vein is not opacified, with a segmental area of low attenuation involving the hepatic parenchyma not exerting a mass effect at segments VI and VII of the liver, consistent with the affected area that is supplied by this vessel appearing as transient hepatic attenuation differences (THAD).

The anterior branch of the right portal and superior mesenteric veins are patent.

The rest of the organs and abdominal vessels appear normal. 

Case Discussion

Initially, ultrasound was requested demonstrated dilated splenic vein with an absent signal on color Doppler examination and was managed accordingly. Three days later following the initiation of treatment CT scan of the abdomen and pelvic with IV contrast was requested demonstrating splenic and posterior branch of right portal veins thrombosis.

PlayAdd to Share

Case information

rID: 74945
Published: 16th Mar 2020
Last edited: 17th Mar 2020
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.