Portal vein thrombosis – a primer for the general physician

Portal vein thrombosis (PVT) has been usually diagnosed as a complication secondary to cardiac, hepatic, and malignant etiologies, but it has rarely been described in the setting of blunt abdominal trauma. This case depicts an older male who presented to the emergency department with progressive ascites and lower extremity edema within two weeks after a motor vehicle accident (MVA). Ascitic fluid analysis indicated the presence of portal hypertension, which prompted extensive evaluation to determine the etiology. Further workup, including hypercoagulable and malignancy screening, unveiled the diagnosis of acute PVT secondary to abdominal blunt force trauma, showing a rather rare presentation.

Section: Discussionmentioning

confidence: 99%

A Case of Disappearing Ascites: Late Presentation of Acute Portal Vein Thrombosis After a Motor Vehicle Accident

Del Rio,

Reveron,

Ramdhaney

2023

“…Because up to a third of patients with PVT may not reveal a thrombus on normal ultrasound, Doppler imaging can be used to show the absence of flow within the vessel lumen [7]. Ultrasound with Doppler imaging has been estimated to be up to 93% sensitive and specific for diagnosing PVT, although the accuracy of the imaging can be affected by individual technical skills of each ultrasonographer [8]. Abdominal CT and MRI can also be used to diagnose PVT.…”

Section: Discussionmentioning

confidence: 99%

A Case of Idiopathic Portal Vein Thrombosis in an Immunocompetent Female

Park¹,

Chong²,

Awwal³

et al. 2021

Portal vein thrombosis (PVT) is characterized by a complete or partial occlusion of the portal vein by a thrombus. The formation of the thrombus is usually attributed to an underlying condition that is causing a hypercoagulable state, such as malignancy or cirrhosis. When these causes are ruled out, a hypercoagulable workup can reveal other underlying prothrombotic etiologies. Still, some cases of PVT occur without any definitive underlying condition, leading to the diagnosis of idiopathic PVT. This occurred in our patient, a 53-year-old female who presented with PVT but had no clear underlying condition that led to her pathology after an extensive medical investigation.

“…Acute PVT is diagnosed with abdominal imaging with contrast-enhanced abdominal computerized tomography (CT), but a Doppler ultrasound could be performed if the suspicion is low [ 5 ]. Acute PVT is managed with anticoagulation [ 6 ], such as low molecular weight heparin, to achieve rapid anticoagulation that can be switched to an oral anticoagulant once the patient's condition stabilizes.…”

Section: Introductionmentioning

confidence: 99%

Portal Vein Thrombosis Extending to the Superior Mesenteric and Splenic Veins Secondary to a Hypercoagulable State Due to Prior Abdominal Surgery, Hormonal Replacement Therapy, and Flaxseed Consumption

Gaibor¹,

Zhang²,

Yang³

et al. 2023

Herein is a case of a 50-year-old male diagnosed with a non-cirrhotic acute portal vein thrombosis (PVT). Acute PVT is a rare condition usually presenting in cirrhotic patients. This patient had no past medical history of cirrhosis or hypercoagulable status and no past family history of a hypercoagulable disorder. However, the patient, who has been on testosterone replacement therapy (TRT) along with over-the-counter flax seeds (commonly known to contain phytoestrogens), recently underwent an abdominal surgery essentially placing him in a hypercoagulable state which could contribute to the development of acute PVT. This case showed the importance of being aware of possible contributors to hypercoagulable states which can lead to the occurrence of these events.