Portal vein thrombosis: Ultrasound imaging

Abstract

Portal venous system, apart from the main portal vein, includes its tributaries: superior and inferior mesenteric vein, as well as splenic vein, so the term portal venous thrombosis encompasses a broad spectrum of pathological conditions. Usually, one or more causative factors can be recognized, either local endothelial/flow disturbances, or systemic inherited/ac-quired conditions. Portal vein thrombosis can be associ-ated with benign or malignant disorders. Weather we are speaking about acute or chronic thrombosis, the clinical presentation is different. Acute thrombosis can be pre-sented in a wide range, from mild abdominal discomfort to a state of intestinal ischemia and life-threatening in-farction. Chronic thrombosis is usually recognized when variceal bleeding or other symptoms of portal hy-pertension express. Fast and accurate diagnosis someti-mes is a life-saving procedure, especially in acute vas-cular alterations. Recently, due to the improvement of imaging procedures the number of patients with diagno-sed portal vein thrombosis is increasingly growing. With a negative predictive value of 98% color Doppler ultrasound is considered as imaging modality of choice in detecting portal vein thrombosis. Based on large stud-ies it is presumed that overall risk of getting portal vein thrombosis during lifetime is 1% in general population, but much bigger 5%-15% in cirrhotic patients. Existen-ce of specific ultrasound criteria, if fulfilled, has ensured that diagnosis of portal vein thrombosis is fast and non-invasive. Procedure is convenient for the patient and healthcare providers, and above all, allows prompt treatment preventing further deterioration.