[Thrombosis of portal cavernoma]

Area of Science:

• Gastroenterology and Hepatology
• Vascular Surgery
• Radiology

Background:

• Portal cavernoma is a venous malformation that can lead to complications like portal hypertension.
• Portal cavernoma thrombosis (PCT) is a rare but serious complication, often presenting insidiously.
• Etiology of portal cavernoma is unknown in 50% of cases, and it is frequently asymptomatic.

Observation:

• A 74-year-old patient presented with abdominal pain, initially suspected to be a pancreatic mass.
• Computed tomography (CT) revealed a non-enhancing mass from the pancreatic head to the hepatic hilum.
• Abdominal magnetic resonance (MR) imaging excluded malignancy and confirmed portal cavernoma thrombosis.

Findings:

• The case highlights PCT as a complication of portal cavernoma, distinct from primary pancreatic or biliary pathology.
• Imaging findings, including CT and MR, were critical in differentiating PCT from other abdominal pathologies.
• The absence of bile duct dilatation despite the mass suggests a specific presentation of PCT.

Implications:

• This case underscores the importance of considering PCT in the differential diagnosis of abdominal masses, especially in the presence of portal hypertension symptoms.
• Increased awareness of PCT among clinicians may lead to earlier diagnosis and appropriate management.
• Further investigation into underlying thrombophilic disorders is warranted in patients diagnosed with PCT to prevent recurrence or identify associated conditions.