Transient hepatic attenuation difference secondary to portal vein thrombosis
Presentation
Routine examination of a patient one month post colorectal carcinoma resection. Suspicious ultrasound findings. No abdominal discomfort, no diarrhea or signs or gastrointestinal bleeding.
Patient Data
Thrombosis of portal and superior mesenteric vein.
Transient hepatic intensity differences (THID) in segmental shape in liver segment 8 secondary to portal hypoperfusion, showing the most intensity difference to the rest of the liver in the arterial perfusion phase due to hepatic arterial compensatory flow.
The thrombus itself (shown in portal vein branch and superior mesenteric vein) does not enhance.
Transient hepatic attenuation difference (THAD) in segmental shape in liver segment 8 secondary to portal hypoperfusion, showing mild hyperdensity to the rest of the liver in the arterial perfusion phase due to hepatic arterial compensatory flow.
Thrombosis of portal and superior mesenteric vein.
Case Discussion
Transient hepatic attenuation difference (THAD), in MRI sometimes called transient hepatic intensity differences (THID), is presented in this case in a segmental shape secondary to portal vein thrombosis and thus secondary to portal hypoperfusion. It shows the most signal and density difference to the rest of the liver in the arterial perfusion phase due to hepatic arterial compensatory flow.
Differential diagnoses should include:
- focal hypervascular lesions, such as hepatocellular carcinoma
- inflammatory lesions
- liver trauma
- arterioportal shunt
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