Acute portal vein thrombosis

Area of Science:

• Gastroenterology
• Vascular Imaging
• Abdominal Surgery

Background:

• Portal vein thrombosis (PVT) is a serious condition that can lead to portal hypertension.
• Chronic calcific pancreatitis and previous pancreatic surgery are risk factors for PVT.
• Acute PVT presents with sudden abdominal pain and clinical deterioration.

Observation:

• Ultrasound revealed a dilated portal vein with low-level echoes, hepatic edema, hepatic artery hypertrophy, splenomegaly, collateral vessels, and ascites.
• Computed tomography (CT) confirmed the diagnosis of acute portal vein thrombosis.
• The study highlights the distinct ultrasonic appearances of acute versus chronic PVT.

Findings:

• Acute portal vein thrombosis was diagnosed in a patient with a history of chronic calcific pancreatitis and two pancreatic surgeries.
• Ultrasound demonstrated characteristic signs of acute PVT, including portal vein dilation and intraluminal echoes.
• CT provided confirmation and detailed vascular assessment, particularly useful in cases of ileus or heavy pancreatic calcification.

Implications:

• Early diagnosis of acute PVT is crucial for appropriate management and prevention of complications.
• Ultrasound is recommended as the initial imaging modality for suspected acute PVT due to its real-time and Doppler capabilities.
• CT is valuable for complex cases, offering detailed anatomical information and vessel patency assessment.