ARRS 2022 Abstracts

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E1200. An In-Depth Review of Pylephlebitis
Authors
  1. Tomer Nawrocki; Staten Island University Hospital
  2. Alexander Song; Staten Island University Hospital
  3. Nassier Harfouch; Staten Island University Hospital
  4. George Michael; Staten Island University Hospital
  5. David Sarkany; Staten Island University Hospital
Background
Pylephlebitis is a septic thrombophlebitis of the portal vein or its tributaries due to an intra-abdominal infection in areas that drain to the portal system. Such infections include diverticulitis, colitis, and appendicitis. Though rare, the mortality rate of pylephlebitis is estimated to be as high as 11–32%.

Educational Goals / Teaching Points
The goals of this exhibit are to understand pylephlebitis as a rare complication of certain intra-abdominal infections; describe current imaging recommendations for the identification and follow-up of pylephlebitis; and review treatment options and mortality rate of pylephlebitis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT is the imaging modality of choice for diagnosing pylephlebitis, as it demonstrates thrombus in the portal system and identifies the underlying source of infection within the abdomen. CT also identifies complications of pylephlebitis such as bowel ischemia, splenic and hepatic infarctions, and hepatic abscesses. Treatment regimens are initially based on broad spectrum antibiotics and then narrowed following results of blood cultures. The use of anticoagulation in pylephlebitis is not yet established. Percutaneous techniques have been reported with aspiration of thrombus and possibly pus from the portal vein. Follow-up imaging of the portal vein is performed approximately 5–7 days following initiation of antibiotics. Incomplete resolution of the thrombus is frequent and does not correlate with worse outcome. However, repeat imaging can detect thrombus extension or other complications that may result in a change of clinical management.

Conclusion
Pylephlebitis is a potentially life-threatening complication of various intra-abdominal infections. CT is the mainstay imaging modality to diagnose and monitor the progression and complications of pylephlebitis.