Diagnostic Pitfalls and Lessons Learned in Portal Hypertension

Noncirrhotic portal hypertension is defined as portal hypertension in the absence of cirrhosis or advanced hepatic fibrosis. We present an 85-year-old man with recurrent hematemesis, initially presumed to have decompensated cirrhosis based on imaging. However, liver biopsy revealed pseudocirrhosis due to sinusoidal infiltration by metastatic spindle cell malignancy. This case underscores the importance of histological confirmation when imaging suggests cirrhosis, as infiltrative malignancies can mimic cirrhosis and produce clinically significant portal hypertension.