Clinical features, diagnosis and outcome of acute portal vein thrombosis

Sheen, Cheng-Han; Lamparelli, H; Milne, Alexander; Green, I; Ramage, John

doi:10.1093/qjmed/93.8.531

Cited by 122 publications

(90 citation statements)

References 12 publications

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“…Sheen et al had shown a low HARI of 0.57 AE 0.11 in patients with portal vein thrombosis viz a viz a HARI of 0.75 AE 0.08 amongst controls. 4 Platt et al in a study of 35 patients with suspicious portal vein thrombosis showed a reduction in hepatic artery resistive index (HARI). He concluded from the study that reduction in HARI could be an objective parameter for portal vein thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 While there are several studies that have reported portal vein and hepatic artery hemodynamics in healthy individuals 3 those with acute portal vein thrombosis, 4 therapeutic portal vein embolization, 5 and hepatic artery stenosis after liver transplant, 6 very few studies have looked into the portal hemodynamics in children with long standing extra hepatic portal vein obstruction (EHPVO). 7,8 Congestive index and venous pulsatility index in the portal vein, both in adult and pediatric patients are determinants of the hemodynamic status of the portal system.…”

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confidence: 99%

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Hepatic Artery Doppler Indices in Children with Extra Hepatic Portal Vein Obstruction

Jesudoss¹,

Chandrasekaran²,

Sathiyasekaran³

et al. 2013

Journal of Clinical and Experimental Hepatology

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Doppler measurement provides information on the hemodynamics in the hepatic artery and the portal venous system. Aim: To study the hepatic artery hemodynamics in children with extra hepatic portal vein obstruction. Materials and methods: Hepatic artery indices were studied using Doppler indices in 15 children (<12 years) with extra hepatic portal hypertension (EHPVO) and obliterated esophageal varices. The hepatic artery resistive index, the arterial acceleration time and the acceleration index were used to determine the flow pattern within the hepatic artery. Controls were 15 healthy age-sex matched children, belonging to the same socioeconomic strata in absence of liver disease. Results: The mean age of the children was 8.43 ± 3.2 years and male female ratio was 4:1. All the children had obliterated esophageal varices. The hepatic artery resistive index in the children with EHPVO was normal and similar to controls. The hepatic arterial early systolic acceleration index was significantly higher in cases compared to controls (436 ± 290 vs 214 ± 100; P value <0.004). The hepatic arterial acceleration time though low in the cases (86 ± 35 cm/s) was not statistically different from the controls (128 ± 14 cm/s). Conclusion: There was a significant increase in hepatic arterial early systolic acceleration in children with chronic EHPVO. The latter may be responsible for an increase in hepatic arterial in flow velocity in a slow flow system despite a normal resistive index. Congestive index and venous pulsatility index in the portal vein, both in adult and pediatric patients are determinants of the hemodynamic status of the portal system. 8,9These indices are not reliable in portal vein thrombosis and portal cavernoma as there is a poor correlation between the size of the portal vein and portal pressure. 7,10 Also, the transformation of the portal vein to a cavernoma makes measurement of these indices difficult.Hepatic artery indices are likely to be more informative 11 under such circumstances. One can get a clue to the hemodynamics of the blood flow in the hepatic artery. Till date, there are no published studies that have reported on hemodynamics in hepatic artery in patients with cavernomatous transformation of the portal vein.McNaughton et al 12 describes the normal hepatic arterial waveform in the hepatic artery to be pulsatile with low resistance. The peak height of the wave corresponds to the peak systolic velocity (V 1 ), and the trough to enddiastolic velocity (V 2 ) The normal resistive index (RI) within the hepatic artery ranges from 0.55 to 0.8. Any measured RI above or below the normal range represents a disease state. 13-15The aim of the present study was to determine the hepatic artery resistive index, the acceleration time and the acceleration index in children with EHPVO. MATERIALS AND METHODSThe Liver Unit at Stanley Hospital predominantly caters to the adult population. The present study included 15 children with EHPVO who were referred to the Liver Clinic for management of variceal bleed. All these...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Hepatic Artery Doppler Indices in Children with Extra Hepatic Portal Vein Obstruction

Jesudoss¹,

Chandrasekaran²,

Sathiyasekaran³

et al. 2013

Journal of Clinical and Experimental Hepatology

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“…Sheen et al 9 demonstrated that 78% of noncirrhotic patients had resolution of their thrombus per CT reassessment after 3 months of oral anticoagulation with an INR range of 2 to 4. Condat et al 10 report in a retrospective study of acute PVT that recanalization occurred in 25 of 27 patients given anticoagulation and 0 of 2 patients without anticoagulation therapy.…”

Section: Treatment For Pvt With the Prothrombin Mutationmentioning

confidence: 99%

Portal Vein Thrombosis: An Unexpected Finding in a 28-Year-Old Male With Abdominal Pain

Ferguson¹,

Hennion²

2008

The Journal of the American Board of Family Medicine

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Background: Abdominal pain is a common primary care complaint. Portal vein thrombosis (PVT) is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia. The following describes the presentation of PVT in a young male, the search for risk factors and underlying etiology, and the debate of anticoagulation therapy.Case: A 28-year-old male presented with periumbilical pain, post-prandial nausea, and sporadic hematemesis for 3 weeks. The diagnosis was confirmed with a triphasic liver computerized tomography after obtaining an abnormal right upper quadrant ultrasound. This unexpected finding prompted investigation for intrinsic hepatic disease and potential hypercoagulable disorders. Laboratory analysis revealed a heterozygous genotype for the prothrombin 20210G/A mutation, an identified risk factor for venous thrombosis.

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“…Nei casi di PVT senza infarto intestinale e a paziente emodinamicamente stabile, la terapia più frequentemente adottata e consigliata è quella che prevede l'uso dell'eparina sia non frazionata sia frazionata, seguita da terapia anticoagulante con warfarin [22][23][24][25][26][27] . La ricanalizzazione del circolo portale in questi casi viene descritta nel 50-80% dei pazienti a fronte di una totale assenza di ricanalizzazione nei pazienti non trattati.…”

Section: Quali Indagini Dovrebbero Essere Fatte Successivamente?unclassified

Portal vein thrombosis

et al. 2005

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Acute portal vein thrombosis (PVT) is un uncommon disease that can be seen in the Emergency Department. In the emergency department setting the diagnosis is difficult because of the variety of clinical presentation but in some clinical presentation patterns the diagnosis should be suspected. Regard to the appropriate radiological abdominal images, color flow Doppler ultrasonography can diagnose the fresh thrombus and spiral CT may be complementary in the diagnosis. The diagnosis differentiation between acute and chronic portal vein thrombosis is important for therapeutic management and prognosis. In stable patient the most common therapy is heparin and warfarin but in some cases thrombolysis can be the treatment of choice. In the patients with intestinal infarction the surgical therapy is strongly indicated. Two cases , one of acute and the other of chronic PVT, are presented and discussed

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Clinical features, diagnosis and outcome of acute portal vein thrombosis

Cited by 122 publications

References 12 publications

Hepatic Artery Doppler Indices in Children with Extra Hepatic Portal Vein Obstruction

Hepatic Artery Doppler Indices in Children with Extra Hepatic Portal Vein Obstruction

Portal Vein Thrombosis: An Unexpected Finding in a 28-Year-Old Male With Abdominal Pain

Portal vein thrombosis

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