Presentation
Abdominal pain. She stopped prophylactic low-dose aspirin since 5 days due to abnormal uterine bleeding.
Patient Data
The portal vein is dilated with isoechoic texture to liver. It shows loss of color Dopler flow suggestive of portal vein thrombosis. Multiple periportal hypoechoic areas are noted.
The superior mesenteric vein is also dilated with no flow on color Doppler.
Dilated portal vein reaching 22 mm with non-opacification with contrast and its intrahepatic branches as well as the superior mesenteric vein with its tributaries and the distal 1.5 cm of splenic vein proximal to porto-mesenteric confluence.
The liver shows perihilar and segment VI areas of decreased density on porto-venous phase, likely areas of perfusion difference.
Multiple splenic hypoattenuating subcapsular wedge-shaped areas, in keeping with multiple splenic infarcts.
Bowel loops are average in caliber with no bowel wall thickenig or signs of ischemia.
Right renal upper pole scarring, may be sequel of previous attack of pyelonephritis.
Case Discussion
Features of extensive portal venous system thrombosis, with multiple splenic infarcts as sequels. Aspirin withdrawal has been reported to be associated with a temporarily increased risk of thrombus formation 1.
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