Transient hepatic attenuation difference secondary to portal vein thrombosis

Case contributed by Yves Leonard Voss

Presentation

Routine examination of a patient 1 month post colectomy for carcinoma. Ultrasound suspicious for portal vein thrombosis. No abdominal discomfort, no diarrhoea or signs or gastrointestinal bleeding.

Patient Data

Age: 70

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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Case information

rID: 50146
Case created: 20th Dec 2016
Last edited: 27th Dec 2016
Inclusion in quiz mode: Included

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