Portal vein thrombosis: imaging findings.

Parvey, H. Richard; Raval, Bharat; Sandler, Carl M.

doi:10.2214/ajr.162.1.8273695

Cited by 101 publications

(40 citation statements)

References 5 publications

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“…CT has high sensitivity and specificity for the diagnosis of splanchnic venous occlusion [12,17,28,31,32]. With contrast-enhanced CT, SMV thrombosis is characterized by a decreased intraluminal density, occasionally combined with a ring enhancement of the vein, because of opacification of the vasa vasorum [28].…”

Section: Discussionmentioning

confidence: 99%

Computed tomography of superior mesenteric vein thrombosis following appendectomy

et al. 1998

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During a 5-year period, superior mesenteric vein (SMV) thrombosis was detected with computed tomography (CT) in six patients shortly after an appendectomy. No sign of SMV was present at appendectomy, and a period of more than 2 weeks free of clinical symptoms had elapsed between the appendectomy and the onset of the SMV thrombosis. In four cases, the appendicitis was complicated. These patients had nonspecific signs and symptoms, although two of them had elevation of blood hepatic enzyme levels. In all cases, postcontrast CT demonstrated enlargement of the SMV, with well-defined enhancement of the vascular wall and an intraluminal clot. In one case, CT showed extension of the thrombus to the portal vein with the presence of low-attenuation areas in the liver, consistent with hepatic infarcts. Two patients had predisposing diseases: idiopathic hypersplenism in one case and chronic hepatic disease in the other. SMV thrombosis is a possible complication of appendicitis, and early appendectomy in appendicitis can prevent this complication. Moreover, as in any abdominal surgery, early appendectomy may be complicated by thrombosis of the SMV, thus creating problems of postoperative diagnosis. The complication is more frequent when the initial operation is performed under difficult conditions (peritonitis), or when the patient presents with a coagulopathy. CT is useful in the diagnosis of SMV thrombosis, thus leading to early management with anticoagulant therapy, with a view to avoiding complications such as intestinal ischemia, portal vein thrombosis, and hepatic infarction.

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Section: Discussionmentioning

confidence: 99%

Computed tomography of superior mesenteric vein thrombosis following appendectomy

et al. 1998

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“…On non-contrast enhanced CT, portal vein thrombus is generally seen to be isodense to adjacent soft tissue, but may be hyperdense if it occurred within a month. 96 Following intravenous administration of iodinated contrast on CT, a bland thrombus is seen as a low density, non-enhancing defect within portal veins, while a tumor thrombus enhances following contrast administration. Moreover dynamic CT shows a filling defect partially or totally occluding the vessel lumen with rim enhancement of the vessel wall.…”

Section: Computed Tomography and Magnetic Resonance Imagingmentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

149

147

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Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

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“…30 CT and MRI have the additional advantages of being able to define the extent of the thrombus, show any evidence of bowel ischaemia/infarction and for looking at other organs surrounding the portal vein. 30,31 The sensitivity and specificity of these techniques have been shown to be 100% and 98%, respectively, in patients awaiting a liver transplant. 32 New techniques like magnetic resonance portography are especially useful in patients who are severely debilitated, in those who have difficult venous access and for patients with renal failure.…”

Section: Imagingmentioning

confidence: 99%