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A rare pediatric case of portal vein aneurysm thrombosis
Tran Thanh Tri1, Ho Phi Duy1, Bui Hai Trung1
1Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, 700000, Vietnam.
Insights
Portal vein aneurysm (PVA) is a rare condition. This case study shows successful conservative treatment of a pediatric PVA with extensive thrombosis, leading to full recovery.
Area of Science:
- Vascular Surgery
- Pediatric Radiology
- Gastroenterology
Background:
- Portal vein aneurysm (PVA) is an uncommon vascular malformation.
- Published literature primarily consists of case reports and small series.
- PVA can present with serious complications like portal venous system thrombosis.
Observation:
- A 10-year-old boy presented with abdominal pain and vomiting.
- Initial ultrasound suggested a pancreatic head tumor.
- Contrast-enhanced CT confirmed a large portal vein aneurysm with occlusive thrombosis.
Findings:
- The patient was treated conservatively with anticoagulant therapy due to a lack of severe symptoms.
- Follow-up Doppler ultrasound at 6 months showed gradual shrinkage and complete resolution of the thrombosis.
- The portal vein aneurysm size decreased, and normal hepatopetal blood flow was restored.
Implications:
- This case highlights the potential for conservative management of pediatric PVA with thrombosis.
- Accurate diagnosis by surgeons and radiologists is crucial for appropriate treatment.
- Awareness of PVA is important for managing rare vascular anomalies in children.
Abstract:
Portal vein aneurysm (PVA) is rarely encountered, and published papers describing this etiology in adults and children typically include only case reports or small case series. We present a clinical case of PVA in a child associated with severe complications, including diffuse thrombosis of the portal venous system. A 10-year-old boy presented with abdominal pain and vomiting, resulting in an initial diagnosis of pancreatic head tumor based on suspicious images on abdominal grayscale ultrasound. Contrast-enhanced computed tomography confirmed a diagnosis of occlusive PVA thrombosis (36 × 37 × 95 mm). Lacking drastic symptoms, the patient was treated with conservative anticoagulant therapy. On follow-up, the thrombosis appeared to shrink gradually and disappeared at 6 months based on Doppler ultrasound imaging. The PVA was reduced in size, and hepatopetal flow was restored. Surgeons and radiologists should be aware of this rare entity to ensure that a precise diagnosis can be established and to provide suitable treatment.
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