Portal vein thrombosis
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.
- Abdominal sepsis
- Abdominal surgery
- Behçet's syndrome
- 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 (e.g. factor V Leiden deficiency, protein C or S deficiency, antiphospholipid antibody syndrome)
- Myeloproliferative syndromes (e.g. polycythemia vera or essential thrombocythemia)
- Oral contraceptives
- Pancreatic islet cell transplantation
- Paroxysmal nocturnal hemoglobinuria
- Retroperitoneal fibrosis
- Splenectomy complication
- Transjugular intrahepatic portosystemic shunt (TIPS)
- 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)
- May be clinically silent in a portion of patients and diagnosed incidentally during a CT exam for other reasons (e.g. acute pancreatitis)
- Often asymptomatic; incidental finding on imaging
- Associated with portal hypertension
- Typically diagnosed on abdominal CT with contrast
- Filling defect on Doppler ultrasound
- EGD to assess for gastric/esophageal varices if chronic PVT
- In non-cirrhotic, LMWH -> warfarin x 6 months
- In non-cirrhotic or hypercoagulable, anticoagulation after screening for varices
- Anticoagulate patients with cirrhosis AND 1) thrombophilia, 2) clot extension in mesenteric veins, or 3) bowel ischemia
- If severe, may require shunt, liver transplant, or bowel resection
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