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A 24-year-old female presented with sudden heart failure and ventricular fibrillation. A complete work-up suggested the existence of primary hypoparathyroidism in an otherwise previously healthy young woman. Left ventricle enlargement was detected by echocardiography with an ejection fraction of 30%. Electrolyte disorders dominated the laboratory results, with severe hypocalcemia, hypokalemia, hypomagnesemia and other changes, which were corrected with infusion therapy. An improvement of her overall condition prompted a switch from electrolyte infusion therapy to the oral route after the first week of treatment. The patient was discharged under calcium, calcitriol, diuretics and angiotensin-converting-enzyme-inhibitors oral maintenance therapy. Two months after discharge, her ejection fraction remained low (33%), although the end-systolic volume had returned to normal values, and her general status had substantially improved. Within a period of 4 months her cardiac function improved significantly and the follow-up surveillance echocardiography showed an ejection fraction of 53%, with normal left ventricle dimensions.

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Introduction: Thrombosis of the portal venous system is rare with prevalence near 1% in the general population reported previously, difficult to diagnose and can be fatal. Case presentation: A 54 year-old white female was admitted to our hospital with 10 days history of vague abdominal pain, nausea, vomiting and fever. Last months she had symptoms suggestive of diabetes mellitus. The degree of her subjective pain was disproportionate to her objective tenderness. Laboratory work-up revealed hyperglycemia, HbA1c 12,4 %,a high total leukocyte count ,lipase and amylase were normal,AST, ALT initially were normal. In the urine-analysis resulted urinary infection and positive ketone. An abdominal computed tomography (CT) with contrast had permitted the diagnosis of portal vein, splenic vein and superior mesenteric vein thrombosis associated with extensive hepatic, lineal, infarction and a tromb in descendent aort. Immediately, an anticoagulant therapy was conducted with intravenous heparin, but after 45 days treatment she died. Results: In our case, the thrombus was secondary to a combination of comorbidities, including dehydration, urinary infection, ketosis and diabetes mellitus and the diagnoses was not made in time. Only a CT abdominal permitted the diagnosis of portal venous system thrombosis. Despite the anticoagulant therapy the result was fatal.

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