Cavernous Transformation of Portal Vein Secondary to Portal Vein Thrombosis: A Case Report

Abstract

There are few reported cases of cavernous transformation of the portal vein (CTPV) in adults. We present a case of a 58 year-old male who was found to have this complication due to portal vein thrombosis (PVT). A 58-year old African American male with chronic alcohol and tobacco use presented with a 25-day history of weakness, generalized malaise, nausea and vomiting associated with progressively worsening anorexia and weight loss. The patient was admitted for severe anemia in conjunction with abnormal liver function tests and electrolyte abnormalities, and to rule out end stage liver disease or hepatic malignancy. The work-up for anemia showed no significant colon abnormalities, cholecystitis, liver cirrhosis, or liver abnormalities but could not rule out malignancy. An esophageogastroduodenoscopy (EGD) was suspicious for a mass compressing the stomach and small bowel. After further work-up, the hepatic mass has been diagnosed as a cavernous transformation of the portal vein (CTPV), a very rare complication of portal vein thrombosis (PVT). Cavernous Transformation of the Portal Vein (CTPV) is a rare and incurable complication of portal vein thrombosis (PVT) that should be considered as one of the differential diagnoses of a hepatic mass.KeywordsCavernous transformation of the portal vein; Portal vein thrombosis; Portal hypertension; Hyperbilirubinemia; Hepatic mass

Portal Vein Thrombosis and Cavernoma Formation in a Patient With Small Vessel Vasculitis

“…It is a phenomenon to help keep liver to retain its functioning in a normal way; however, if this cavernous formation is unable to handle mesenteric and splenic inflow, the formation of pre-sinusoidal portal hypertension or cirrhosis ensues. Obstruction of portal veins was first diagnosed in 1869 by Stewart and Balfour in a patient with variceal dilation, enlarged spleen and ascites [4]. Clinical presentation depends on the timing and progression of thrombosis and collateral formation.…”

“…It may reveal abnormal growth of portal venous channels and can be supplemented with color Doppler which has 90% sensitivity of PVT diagnosis [4]. The diagnosis may also be confirmed by performing a CT scan and/or MRI with greater anatomical details.…”

Clinical management of advanced schistosomiasis: a case of portal vein thrombosis-induced splenomegaly requiring surgery

“…CTPV occurs in patients with PVT due to the obstruction to the flow of portal blood leading to the development and dilation of multiple small vessels in and around the recanalising main portal vein. The cause of CTPV is not known, but it can occur in healthy livers with chronic non-cirrhotic and non-tumoural PVT 21 22. Third, small siderotic nodules of the spleen, called γ-Gandy bodies, have been seen on MRI in patients with portal vein or splenic vein thrombosis 23.…”

Portal biliary ductopathy caused by cavernous transformation of the portal vein

“…Ramos et al 2 reported a case of a 58-year-old man with cavernous transformation of the portal vein secondary to PVT who presented with anaemia, electrolyte imbalance and deranged LFTs. In this case, no intervention was offered as the patient was considered a poor candidate for an invasive procedure and the LFTs improved spontaneously.…”