Portal vein thrombosis

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
• Cholangiocarcinoma
• Cirrhosis
• Collagen vascular diseases (eg, lupus)
• Compression or invasion of the portal vein by tumor (eg, pancreatic cancer)
• Diverticulitis
• 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)
• Omphalitis
• Oral contraceptives
• Pancreatic islet cell transplantation
• Pancreatitis
• Paroxysmal nocturnal hemoglobinuria
• Pregnancy
• Retroperitoneal fibrosis
• Splenectomy complication
• Transjugular intrahepatic portosystemic shunt (TIPS)
• 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

Evaluation

• Typically diagnosed on abdominal CT with contrast

See Also

Budd-Chiari syndrome (hepatic vein thrombosis)