Presentation
Recent splenectomy and cholecystectomy due to hemolytic anemia caused by hypersplenism. Now complaining of severe epigastric and left upper quadrant pain.
Patient Data
The splenic vein, portal vein, and their intrahepatic branches appear non-enhancing, suggesting splenic and portal vein thrombosis.
The superior mesenteric vein appears partially enhancing, with some branches patent and others thrombosed.
The inferior mesenteric vein appears patent.
There is a mild amount of abdominopelvic ascites.
The pancreas appears mildly swollen with fat stranding, and free fluid is observed in the left upper abdomen at the site of recent surgery surrounding the tail of the pancreas. Given that lipase and amylase levels were normal, it is thought that these changes are mostly due to recent surgery rather than pancreatitis.
The stomach shows wall thickening with a few air foci in its wall.
The proximal duodenum and proximal jejunum show wall thickening.
A few well-defined round enhancing lesions are seen at the splenic bed, mostly unresected splenules.
Subcutaneous emphysema is observed, likely due to recent surgery.
Case Discussion
Acute portal vein thrombosis is a serious life-threatening condition.
Thrombolysis or thrombectomy are the mainstay of management.
It is essential to differentiate bland thrombus from tumor thrombus by looking for thrombus enhancement.
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