Diagnosis of major abdominal venous thromboses is difficult.' Correct diagnosis can be made by angiography, computed tomography (CT), or ultras0nography.l-" We report a case in which superior mesenteric venous thrombosis and progressive thrombosis involving the portal and splenic veins were demonstrated by ultrasound.
CASE REPORTA 45-year-old male with a previous history of alcohol abuse was admitted with complaints of nausea, epigastric pain, and rigors of short duration. On examination he was febrile (38.3"C oral) with a pulse rate of 100/min. No cardiovascular or lung abnormality was present. On abdominal palpation there was marked tenderness in the epigastrium. No other clinical abnormality was present.
Laboratory investigations showed elevated ESR(90 mm at the end of first hour) and leucocytosis (WCC 23.3 x 10g/liter). Hemoglobin was 14.8 g/dl, and serum amylase was 119 IU/liter.Chest and abdominal radiographs showed no abnormality. Real-time ultrasonic examination (Technicare Autosector with a 5.0-MHz transducer) on the day of admission revealed a thrombus in the superior mesenteric vein (Fig. lA,B).The portal and splenic veins were normal. The liver, spleen, and pancreas also appeared normal. On the basis of these findings the patient was heparinized.Within the next week, the patient had gastroscopy and barium meal/follow-through studies, which revealed no abnormality. The patient continued to receive anticoagulant therapy and was rescanned 1 week following admission, when partial resolution of the thrombus was seen ( Fig. 2A,B).Two weeks following admission the patient again complained of severe abdominal pain radiating to the back. There were no significant clinical findings. Serum amylase was slightly elevated at 147 IU/liter. Ultrasonic examination at this stage revealed the presence of thrombi in the portal and splenic veins (Fig. 3A,B) in addition to the superior mesenteric vein.In view of further episodes of abdominal pain and persistent ultrasonic findings, exploratory laparotomy was carried out 3 weeks after admission. This revealed a solid portal vein, an indurated and inflamed pancreas, and some enlarged nodes along the pancreas and in the region of the porta hepatis. One of the parapancreatic nodes was removed. No further surgical procedures were carried out, there being no other visceral abnormality. Histology of the node showed reactive lymphadenitis but no evidence of secondary malignancy.During convalescence the patient developed right calf pain. Venography showed diffise thrombi in the popliteal, distal femoral, and external iliac veins. Anticoagulant therapy was continued. There were no further episodes of abdominal or calf pain. He was discharged on maintenance anticoagulant therapy 5 weeks after admission. At review 1 month later he had no complaints and had gained weight. A t subsequent reviews (6 months and 1 year) he remained well. Ultrasonic examinations on these occasions were unremarkable except for a number of small vascular structures in the region of the porta hepatis suggestiv...
