Portal vein thrombosis

Revision as of 01:13, 24 April 2020 by Cooleyc (talk | contribs) (→‎Background: defintion)

Background

Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, leading to increased pressure in the portal vein system and reduced blood supply to the liver.

Inciting Causes

  • Abdominal sepsis
  • Abdominal surgery
  • Behçet's syndrome
  • Cirrhosis
  • Collagen vascular diseases (eg, lupus)
  • Compression or invasion of the portal vein by tumor (eg, pancreatic cancer)
  • Endoscopic sclerotherapy
  • Hepatocellular carcinoma
  • Inflammatory bowel disease
  • Inherited thrombophilias
  • Myeloproliferative syndromes
  • Omphalitis
  • Oral contraceptives
  • Pancreatic islet cell transplantation
  • Pancreatitis
  • Paroxysmal nocturnal hemoglobinuria
  • Pregnancy
  • Retroperitoneal fibrosis
  • Transjugular intrahepatic portosystemic shunt
  • Trauma

Clinical Features

Acute

  • Upper abdominal pain developing suddenly or progressing over a few days
  • Possibly accompanied by nausea, hepatomegaly, splenomegaly; may be accompanied by persistent non-spiking fever in the setting of systemic inflammation
  • Other signs/symptoms based on underlying cause (e.g. bleeding disorders, hepatic stigmata if due to cirrhosis)

Chronic

  • May be clinically silent in a portion of patients and diagnosed incidentally during a CT exam for other reasons (e.g. acute pancreatitis)
  • Associated with portal hypertension

Differential Diagnosis

Evaluation

  • Typically diagnosed on abdominal CT with contrast

Management

Disposition

See Also

External Links

References