Acute Portal Vein Thrombosis Diagnosed with Point-of-care Ultrasonography

Abstract

Abdominal pain is the most common presenting complaint to the emergency department (ED);1 however, acute portal vein thrombosis is an uncommon cause of abdominal pain. In the following case report, we present a patient who presented to the ED with symptoms of gastroenteritis but was ultimately diagnosed with acute portal vein thrombosis by point-of-care ultrasound (POCUS).

Point-of-Care Ultrasound Identification of Portal Vein Thrombosis in a Pediatric Patient

“…12,13 The use of oral contraceptives, myeloproliferative disorders, inflammatory disease, and malignancy coagulopathies have also been implicated as risk factors for portal vein thrombosis. 2,11,14 Acute portal vein thrombosis results in severe abdominal pain, ileus, and nonbloody diarrhea. 2,11,14,15 Rarely, the presenting manifestations can include gastrointestinal hemorrhage secondary to hemorrhagic intestinal infarction or esophageal varices.…”

“…6,8 However, up to one third of the patients with portal vein thrombosis will not have an echogenic thrombosis on ultrasound. 3,14,15 Subsequent assessment with color Doppler ultrasound considerably increases the sensitivity (88%-98%) and specificity (80%-100%) for detecting acute portal vein thrombosis. 2,3,5,7 The presence of a distended portal vein with an absence of color Doppler signal within the portal vein is suggestive of thrombus.…”

“…Acute portal vein thrombosis results in severe abdominal pain, ileus, and nonbloody diarrhea 2,11,14,15 . Rarely, the presenting manifestations can include gastrointestinal hemorrhage secondary to hemorrhagic intestinal infarction or esophageal varices 2,11 .…”

“…Ultrasound assessment with color Doppler is a reliable test to visualize the portal vein flow noninvasively and diagnose portal vein thrombosis 2,14,15 . Grayscale ultrasound can be used for the initial screening for acute portal vein thrombosis 6,8 .…”

“…2,11,14 Acute portal vein thrombosis results in severe abdominal pain, ileus, and nonbloody diarrhea. 2,11,14,15 Rarely, the presenting manifestations can include gastrointestinal hemorrhage secondary to hemorrhagic intestinal infarction or esophageal varices. 2,11 More commonly, patients present with abdominal pain in the right upper quadrant, pyrexia, anorexia, and may have associated weight loss and jaundice.…”