Thrombosis of a portal vein aneurysm: a case report with literature review

Abstract

Objectives: Portal vein aneurysm is an unusual vascular dilatation of the portal vein. The etiology, diagnosis and management are ill-defined. Methods: A case of a portal vein aneurysm complicated with complete thrombosis is presented with a literature review providing an overview of the etiology, clinical presentation and management.Results: Portal venous aneurysms represent approximately 3% of all venous aneurysms with a reported prevalence of 0.06%. The reported incidence is on the rise with increasing use of modern imaging techniques in clinical practice. Usually, portal vein aneurysms are incidental findings and patients are asymptomatic. They can be congenital or acquired and portal hypertension represents the most frequent cause of the acquired version. Various complications such as biliary tract compression, portal vein thrombosis, and rupture can occur. Treatment options are conservative management or surgery. Surgical treatment is currently reserved for symptomatic patients with severe abdominal pain, symptoms of pressure effect or with expanding aneurysms, and/or complications such as thrombosis or rupture. Conclusion: Conservative management seems the best option in the majority of patients. A multidisciplinary approach discussing the best option on a case-by-case base in light of their individual underlying risk and symptoms is advised.

Portal Vein Aneurysm Complicated by Thrombosis

“…Portal vein aneurysms are defi ned as having a portal vein diameter of > 1.9 cm in patients with cirrhosis and > 1.5 cm in healthy patients, or a portal vein extrahepatic diameter of > 2 cm and an intrahepatic diameter of > 0.9 cm [3][4][5][6]9] . Our patient had a portal vein diameter of 5.6 cm.…”

“…The most common cause of acquired PVA is portal hypertension, the result of a combination of hyperdynamic blood fl ow and increased portal pressure that induces thickening of the vessel intima, leading to compensatory medial hypertrophy of the vessel. The thickened intima is gradually replaced by fi brous connective tissue that compromises the structural integrity of the venous wall, leading to a reduction in tensile strength and increasing the susceptibility to aneurysmal dilation [4,9] . Other causes include pancreatitis, trauma, and invasion by malignancy [2,5,6,9] .…”

“…The thickened intima is gradually replaced by fi brous connective tissue that compromises the structural integrity of the venous wall, leading to a reduction in tensile strength and increasing the susceptibility to aneurysmal dilation [4,9] . Other causes include pancreatitis, trauma, and invasion by malignancy [2,5,6,9] . Extrahepatic PVAs are more common than intrahepatic PVAs: Of the 190 reported cases of PVA, three were found in the right portal branch, one in the left portal branch, and 19 in the umbilical portion of the left portal vein [6] .…”

“…Gastrointestinal bleeding occurred in 7.3% [6] of cases, as well as symptoms related to compression of adjacent structures (abdominal distension, jaundice, etc.) [2,4,6,9] (Table 1).…”

“…Portal vein aneurysms usually remain stable in size and do not progress [6] , 63% of them being extrahepatic. Portal vein aneurysms of > 5 cm are extremely rare [9] . We report here the 191 st case of PVA.…”