Portal vein thrombosis radiology reference article. An equivalent clot in the vasculature that exits the liver carrying deoxygenated blood to the right atrium via the. Other important causes other important causes cirrhosis in adults. Update on management of portal vein thrombosis and the role. Mechanisms leading to thrombosis are still unclear 1. Large cohort studies have reported a global prevalence of 1%, but in some risk groups it can be up to 26%. Portal vein thrombosis pvt is encountered in a variety of clinical settings such as myeloproliferative diseases, cirrhosis, cancer or infection. Portal vein thrombosis is a pathological condition concerning the liver in which the portal vein which carries blood from the intestines to the liver gets blocked or thrombosed as a result of a clot. Its importance lies in the surgical approach employed, which is determined by the extent of thrombosis, and the presenceadequacy of collateral vessels that can potentially. Pdf characterization of portal thrombosis by contrast. Mechanisms of thrombosis maureane hoffman, md, phd professor of pathology. Portal vein thrombosis pvt is a rare disorder that is associated with a variety of underlying conditions. Introduction venous thromboses are thought to occur due to a combination of factors, both acquired immobility, malignancy, endothelial injury.
Splanchnic vein thrombosis svt refers to thrombosis occurring in the splanchnic venous circulation, which drains the digestive system from the lower oesophagus to the upper twothirds of the rectum. The jak2 v617f mutation frequently occurs in patients with. Management of acute noncirrhotic and nonmalignant portal. The main exposure variable was the presence of occlusive pvt.
Imaging revealed the presence of multiple nonocclusive thrombi involving the. It usually happens in the setting of another disease such as pancreatitis, cirrhosis, diverticulitis or cholangiocarcinoma. Portal vein thrombosis pvt is the blockage or narrowing of the portal vein by a thrombus. The portal vein with its right and left main branches and splenic vein are distended with luminal thrombosis with mild enhancement of portal venous wall. Portal vein thrombosis definition nci the formation of a blood clot thrombus in the portal vein.
Causes of pvt are cirrhosis, hepatobiliary malignancy, abdominal infectious or. Jak2v617f mutation in patients with portal vein thrombosis. Oct 24, 2017 portal vein thrombosis pvt is a blood clot of the portal vein, also known as the hepatic portal vein. Portal vein thrombus may be either bland andor malignant i.
Since the first description of portal vein thrombosis pvt by balfour and stewart in 1869, in their report of a 20yearold patient who died from complications of splenomegaly, ascites, and varicose dilation with associated pvt, the clinical manifestations and management of pvt have been met with great interest. However, increased use of abdominal imaging has noted a large number of incidental pvt. The effects of occlusive portal vein thrombosis pvt on the survival of patients with cirrhosis are unknown. Treatment modalities described include conservative management, anticoagulation, thrombolysis, and thrombectomy. Know the causes, symptoms, treatment and diagnosis of portal vein thrombosis. Occlusion of the portal vein by thrombus portal vein thrombosis pvt typically occurs in patients. Portal vein thrombosis pvt is common in cirrhosis and leads to inferior outcomes. Portal vein thrombosis, mortality and hepatic decompensation. The aim of this retrospective study was to describe risk factors, clinical presentation, complications, and treatment of portal vein thrombosis in a single center. Pdf portal vein thrombosis pvt is a rare event in the general medical setting that commonly complicates cirrhosis with portal hypertension, and can. The frequency is surprisingly high compared with other abdominal operations.
It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. Portal vein pv thrombosis pvt is commonly seen in patients with cirrhosis and may be. If the thrombus remains, portal venous hypertension and varices may result. Portal vein thrombosis and survival in patients with cirrhosis. Portal vein thrombosis liver and gallbladder disorders. Pdf portal vein thrombosis pvt is a rare event in the general. Portal venous phase c and delayed 5 minute contrastenhanced d mr images show signal void arrow within mildly dilated thrombosed portal vein. A consecutive series of 108 adult patients with portal vein thrombosis n 77 and buddchiari syndrome n 31 referred for hemostasis evaluation was retrospectively studied, with a median. Portal vein thrombosis affects the hepatic portal vein, which can lead to portal hypertension and reduction of the blood supply to the liver. Jul 18, 2019 venous thrombosis are more common than arterial ones 1,2. The most frequent localization is hepatic veins 40% 2 leading to budd chiari syndrome but other abdominal sites like portal, mesenteric and splenic thrombosis are less frequently affected in addition to cerebral thrombosis 1. Ct scan of the abdomen with contrast confirmed the diagnosis of portal vein thrombosis pvt figure 2. This study showed complete thrombosis of the main, right, and left portal veins. Inherited thrombophilia, such as factor v leiden mutation and prothrombin g20210a gene mutation, have been asso ciated with pvt.
Portal vein thrombosis as a rare cause of abdominal pain. Natural history of nontumorous portal vein thrombosis in cirrhosis and possible. In the english literature, portal vein obstruction was first reported in 1868 by balfour and stewart, who described a patient presenting with an enlarged spleen, ascites, and variceal dilatation. Portal vein thrombus may be either bland andor mali. Evaluation and management of acute and chronic portal vein thrombosis in patients with cirrhosis kellie young, m. Guidance for the treatment of deep vein thrombosis and. This vein allows blood to flow from the intestines to the liver. The vast majority of cases are due to primary thrombosis of the portal vein. Sixtyseven patients were identified in the electronic. Portal vein thrombosis pvt is a blood clot of the portal vein, also known as the hepatic portal vein. Even when a blood vessel is not injured, blood clots.
Aug 15, 2007 portal vein thrombosis pvt is increasingly frequently being diagnosed, but systematic descriptions of the natural history and clinical handling of the condition are sparse. Mar 21, 2018 portal vein thrombosis is a pathological condition concerning the liver in which the portal vein which carries blood from the intestines to the liver gets blocked or thrombosed as a result of a clot. The portal vein is a vital vasculature providing up to 75% of blood supply to the liver. Portal vein thrombosis a primer for the general physician. Pain associated with dvt is often described as being a cramp or ache in the calf or thigh. Pain associated with dvt is often described as being a. Management of portal vein thrombosis in patients with cirrhosis is more controversial. Inherited thrombophilia and portal vein thrombosis in.
An underlying coagulation disorder such as factor v. Venous thrombosis are more common than arterial ones 1,2. Portal and mesenteric vein thrombosis in a patient with jak2 v617f mutation darren pan and rena callahan, m. Portal vein thrombosis pvt is increasingly frequently being diagnosed, but systematic descriptions of the natural history and clinical handling of the condition are sparse. Characterization of portal thrombosis by contrastenhanced ultrasonography ceus.
The portal vein is one of the splanchnic veins, formed at the confluence of. Classifications of nonneoplastic portal vein thrombosis in patients with cirrhosis however, the most widely used classification is the one proposed by yerdel et al 10. Overview of complications, general management, and prognosis view in chinese. Anti coagulation treatment, factor v leiden mutation, portal vein thrombosis. When a blood vessel a vein or an artery is injured, the body uses platelets thrombocytes and fibrin to form a blood clot to prevent blood loss. This was a retrospective cohort study at a single center. Toward a comprehensive new classification of portal vein. Portal vein thrombosis pvt is a rare condition that affects both children and adults.
Portal vein thrombosis pvt is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Update on management of portal vein thrombosis and the role of. Efficacy and safety of anticoagulation for portal vein. A contrastenhanced abdominal ct scan identified splenomegaly with infarcts, and portal and splenic vein thrombosis without cavernoma formation figs. Portal vein pv thrombosis pvt is commonly seen in patients with cirrhosis and may be incidentally diagnosed in asymptomatic patients during routine imaging. The following describes the presentation of pvt in a young male, the search for risk factors and underlying etiology, and the debate of anticoagulation therapy. Insulin resistance and portal vein thrombosis clinical diabetes. Portal vein thrombosis is blockage or narrowing of the portal vein the blood vessel that brings blood to the liver from the intestines by a blood clot. Inherited disorders include factor v leiden deficiency and mutations in the prothrombin gene g20210a as well as deficiencies of various intrinsic anticoagulation factors, such as protein c and protein s, and activated protein c resistance. It is a major cause of noncirrhotic presinusoidal portal hypertension. Portal vein thrombosis may be seen in a variety of clinical contexts, and when acute can be a lifethreatening condition. At the same time, pvt may be overlooked in the absence of the characteristic symptoms. Dec 11, 2017 inherited and acquired disorders of the coagulation pathway are frequent causes of portal vein thrombosis.
The superior mesenteric and inferior mesenteric veins, as well as their branches, are completely thrombosed mesenteric venous occlusion. Diagnosis, development, and treatment of portal vein. Portal vein thrombosis after laparoscopic sleeve gastrectomy. Portal vein thrombosis pvt is defined as an obstruction of the portal vein or its branches, which include the splenic, superior mesenteric, and inferior mesenteric veins1. Axial t1weighted arterial phase mr image b shows prominent arterial branch arrow. Blood clotting where it shouldnt or when you dont want it to. It originates posterior to the pancreas by the confluence of superior mesenteric and splenic veins, and, prior to entering into the liver, it divides into the left and right portal vein. Management of nonneoplastic portal vein thrombosis in the. Portal and mesenteric vein thrombosis in a patient with jak2. Introduction venous thromboses are thought to occur due to a combination of factors, both acquired immobility, malignancy, endothelial injury and genetic. The primary outcome measure was timedependent mortality.
There are many causes such as preexisting liver diseases, liver cancer, infections, inflammation, and others as well. Clinical features, diagnosis and outcome of acute portal vein. No definitive evidence exists regarding the treatment of acute portal vein thrombosis pvt. Portal vein thrombosis pvt in the general population is a rare event, but it occurs relatively frequently in patients with liver cirrhosis and its prevalence increases with the severity of the disease. Evaluation and management of acute and chronic portal vein. Portal vein thrombosis is a blood clot that blocks the portal vein, which is the blood vessel that travels from the intestines to the liver. Portal vein thrombosis pvt is one of the most common vascular disorders of the liver with significant morbidity and mortality. Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema.
Most people have no symptoms, but in some people, fluid accumulates in the abdomen, the spleen enlarges, andor severe bleeding occurs in the esophagus. Feb 23, 2015 portal vein thrombosis pvt is the blockage or narrowing of the portal vein by a thrombus. After excluding the possibility of cirrhosis, the patient was switched from subcutaneous heparin prophylaxis to iv heparin and later bridged to warfarin. Portal vein thrombosis pvt was first reported in a patient with liver cirrhosis, with detection of phlebothrombosis in the portal system, in 1869. Myeloproliferative disorders mpds, whether overt or latent, represent a main intrinsic factor for the development ofthrombosisintheportal,mesenteric,andhepaticareas47. Renal biochemistry and full blood count were normal. Gastroenterology 2017 may 4 a small metaanalysis shows higher recanalization, lower cirrhosis progression, and no excess bleeding risk. Prothrombin g20210a and factor v leiden mutations were associated with pvt risk in patients with cirrhosis in these data. What is portal vein thrombosiscausessymptomstreatment. A 21yearold caucasian male presented with a short history of epigastric pain and weight loss. It is associated with numerous conditions including malignancy, myeloproliferative disorders, inflammatory conditions such as pancreatitis, intra. The aim of this retrospective study was to describe risk factors, clinical presentation, complications and treatment of portal vein thrombosis in a singlecentre. Portal vein thrombosis pvt is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia.
Portal and mesenteric vein thrombosis in a patient with. In addition, indications and limits of anticoagulant therapy are discussed in detail. However, there are data to support treatment of specific patients with anticoagulation agents. Acute portal vein thrombosis is a difficult clinical diagnosis because of the wide variety of clinical presentations. Portal vein thrombosis pvt is defined by partial or complete thrombosis of the main, right, or left portal vein, by extension of thrombus into the intrahepatic portal vein branches or the. Inherited thrombophilia, such as factor v leiden mutation and prothrombin g20210a gene mutation, have been associated with pvt. Portal vein thrombosis pvt is a serious problem with a high morbidity and mortality, often exceeding 40% of affected patients. Portal vein thrombosis is a rare condition characterized by presence of luminal partial or. Recently, pvt has been reported in patients after laparoscopic sleeve gastrectomy lsg. Portal vein thrombosis pvt is thrombosis of the portal circulation, which may present with varied symptoms. Activated pc along with cofactors protein s and factor v cause factor viii. Insulin resistance and portal vein thrombosis clinical.
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