E2918. Cirrhosis and Beyond: Causes and Management of Portal Vein Thrombosis
Authors
Stephanie Jankovic;
Oregon Health and Science University
Gail Stanton;
Oregon Health and Science University
Marc Michael Lim;
Oregon Health and Science University
Background
Portal vein thrombosis is often encountered in patients with altered portal flow dynamics due to cirrhosis and portal hypertension. However, it can also occur after direct injury; hypercoagulable states due to inherited thrombophilia, infection, vasculitis, autoimmune or other inflammatory conditions; and malignancy, such as myeloproliferative neoplasms with JAK2 kinase mutations.
Educational Goals / Teaching Points
Recognizing the patterns and downstream sequelae of acute and chronic portomesenteric thrombosis can appropriately direct patient management. Acute portomesenteric thrombosis has a high mortality rate; however, endovascular therapies can be effective in preserving bowel and liver function acutely and in decompressing varices and alleviating ascites in chronic thrombosis.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Etiology and epidemiology of portomesenteric venous thrombosis (PVT). Acute versus subacute versus chronic PVT including pathophysiology, symptoms, laboratory values, and noninvasive imaging. Sequelae including ascites and varices. Treatment including medical, surgical, endovascular. Approach including transjugular, transsplenic, transhepatic, and transmesenteric.
Conclusion
Portomesenteric venous thrombosis can present in the acute, subacute, or chronic stages has various inciting factors and in turn different treatment pathways. Endovascular treatment via multiple approaches can provide preservation of bowel and liver function acutely and decompression of varices and alleviate ascites in the chronic setting. An understanding of the pathophysiology can allow the diagnostic and interventional radiologist to promptly recognize the imaging features and sequelae and recommend appropriate management.
