Ultrasound diagnosis of portal vein thrombosis following splenectomy

Tudway, D.; Sangster, Guillermo

doi:10.1136/pgmj.62.734.1153

Cited by 9 publications

(3 citation statements)

References 13 publications

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“…The clinical picture depends on the acuity and extent of the thrombus, portal hypertension, collateralization, and regional lymph flow (72). It may be symptomless or accompanied by minor complaints in the upper abdomen, or it may be very painful, accompanied by variceal bleeding and shock due to mesentery infarction and paralytic ileus (64). PVT is usually diagnosed by imaging methods.…”

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confidence: 99%

Imaging and radiological interventions of portal vein thrombosis

et al. 2005

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Portal vein thrombosis (PVT) is diagnosed by imaging methods. Once diagnosed by means of ultrasound, Doppler ultrasound can be performed to distinguish between a benign and malignant thrombus. If further information is required, magnetic resonance angiography or contrast-enhanced computed tomography is the next step, and if these tests are unsatisfactory, digital subtraction angiography should be performed. Many papers have been published dealing with alternative methods of treating PVT, but the material is fairly heterogeneous. In symptomatic non-cavernomatous PVT, recanalization using local methods is recommended by many authors. Implantation of transjugular intrahepatic portosystemic shunt is helpful in cirrhotic patients with non-cavernomatous PVT in reducing portal pressure and in diminishing the risk of re-thrombosis. In noncirrhotic patients with recent PVT, some authors recommend anticoagulation alone. In chronic thrombotic occlusion of the portal vein, local measures may be implemented if refractory symptoms of portal hypertension are evident.

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confidence: 99%

Imaging and radiological interventions of portal vein thrombosis

et al. 2005

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“…However, CT evaluation may be more accurate during the 1st postoperative week because bowel distention and ileus may limit ultrasound examination. The flexibility of Doppler ultrasound in allowing the visualization of vessels along their long axes is a clear advantage [46]. Venous thromboembolism occurs in approximately 10% of splenectomized patients, and prophylactic anticoagulation is warranted in patients undergoing splenectomy for hematologic diseases [3].…”

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confidence: 99%

Life-Threatening Massive Thromboembolism After Laparoscopic Splenectomy in an Idiopathic Thrombocytopenic Patient

Uz¹,

Duzenci²,

Atlı³

et al. 2014

G.J. Hematol. Blood Trans.

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A life-threatening massive thromboembolism is reported that developed after laparoscopic splenectomy in a 57-year-old female with idiopathic thrombocytopenic purpura (ITP). Although asymptomatic, she underwent splenectomy because of poor response to steroids and intravenous (IV) gamma globulin. Thirteen days after splenectomy, she suffered portal and mesenteric emboli, followed by pulmoner emboli and left popliteal thrombophlebitis. Extensive workup for hypercoagulable states was negative. Low molecular weight heparin (LMWH) was initiated at a suboptimal dose because of thrombocytopenia. During follow-up, her platelet count increased gradually. Whenever the platelet count had remained stable at > 50 x 10 9 /L, she received full dose of LMWH treatment. Over the next 38 days, her pain resolved, she tolerated a full diet, and sent home. Follow-up imaging studies demonstrated a recanalized portal vein and totally resolved pulmonary arteries. We thought that, consumption of platelets in the massive thromboembolism sites including portal, mesenteric and pulmoner vascular beds had resulted in deep thrombocytopenia, which improved gradually with anticoagulant therapy.

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“…Color Doppler ultrasound being noninvasive, portable, easily available with quick examination time is an investigation of choice for identifying portal vein thrombosis. It also provides information about the hemodynamic alterations in the hepatic portal system like pressure, direction, and velocity of flow, with a sensitivity of 85.7–89% and a specificity of 96–100% [ [18] , [19] , [20] ]. In the case of portal vein stenosis there is a high flow velocity, reduce diameter and area and in portal vein thrombosis, there is an absence flow, increase diameter, and area [ 21 ].…”

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confidence: 99%