Presentation
Complaints of abdominal pains two months post splenectomy.
Patient Data
The splenic fossa is empty (post-splenectomy).
The liver organ surface appears diffusely hetero-hypoechoic in reflectivity with thickened and exuberantly echogenic periportal walls. The main portal vein and the intra-hepatic portal tracts exhibit intraluminal heterogeneous materials predominantly of hypoechoic reflectivity. Spectral Doppler imaging of the portal veins shows insignificant Doppler signals.
The gall bladder is noncalculus though, with a thickened wall outline and mild peripheral fat stranding.
Relative enlargement of the pancreas organ with a mild coarse parenchymal echo pattern is noted. There is minimal right lower abdominal quadrant free fluid.
Case Discussion
Status post-splenectomy with features suggesting partially occlusive acute portal venous thrombosis with periportal fibrotic changes and likely parenchymal liver disease. The reticular pattern appearance of the intra-hepatic parenchymal lobular areas plus the visibly thickened and fibrosed periportal walls, are some of the hallmark sonographic features in schistosomiasis Mansoni type, and/or with liver cirrhosis 1-3. Associated features of acute pancreatitis are evident.
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