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Portal Vein Occlusion
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Portal vein thrombosis (PVT)
              • Definitions

                • Acute, chronic, or neoplastic occlusion of PV due to thrombosis or tumor invasion
                • Chronic PV occlusion with numerous periportal collaterals is referred to as cavernous transformation

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Angiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Kwon JH et al: Diagnostic role of contrast-enhanced ultrasound in the discrimination of malignant portal vein thrombosis in patients with hepatocellular carcinoma. Anticancer Res. 40(8):4351-63, 2020
                                                2. Zhao ZL et al: Imaging and pathological features of idiopathic portal hypertension and differential diagnosis from liver cirrhosis. Sci Rep. 10(1):2473, 2020
                                                3. Gawande R et al: MRI in differentiating malignant versus benign portal vein thrombosis in patients with hepatocellular carcinoma: value of post contrast imaging with subtraction. Eur J Radiol. 118:88-95, 2019
                                                4. Aumann EK et al: Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus. Abdom Radiol (NY). 43(9):2270-6, 2018
                                                5. Jha RC et al: Portal vein thrombosis: imaging the spectrum of disease with an emphasis on MRI features. AJR Am J Roentgenol. 211(1):14-24, 2018
                                                6. Tarantino L et al: Contrast-enhanced ultrasound in differentiating malignant from benign portal vein thrombosis in hepatocellular carcinoma. World J Gastroenterol. 21(32):9457-60, 2015
                                                7. Girleanu I et al: Natural course of nonmalignant partial portal vein thrombosis in cirrhotic patients. Saudi J Gastroenterol. 20(5):288-92, 2014
                                                8. Francoz C et al: Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol. 57(1):203-12, 2012
                                                9. Gaba RC: Chemoembolization practice patterns and technical methods among interventional radiologists: results of an online survey. AJR Am J Roentgenol. 198(3):692-9, 2012
                                                10. Maconi G et al: Portal vein thrombosis in inflammatory bowel diseases: a single-center case series. J Crohns Colitis. 6(3):362-7, 2012
                                                11. Qi X et al: Degree of portal vein thrombosis might be associated with recanalization during anticoagulation. Clin Gastroenterol Hepatol. 10(7):820, 2012
                                                12. Rodríguez-Castro KI et al: Optimal length of anticoagulant therapy in cirrhotic patients with portal vein thrombosis. Clin Gastroenterol Hepatol. 10(7):820-1, 2012
                                                13. Senzolo M et al: Prospective evaluation of anticoagulation and transjugular intrahepatic portosistemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int. 32(6):919-27, 2012
                                                14. Park DE et al: Chylous ascites caused by acute pancreatitis with portal vein thrombosis. J Korean Surg Soc. 81 Suppl 1:S64-8, 2011
                                                15. Rossi S et al: Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol. 18(8):1749-56, 2008
                                                16. Tublin ME et al: Altered liver morphology after portal vein thrombosis: not always cirrhosis. Dig Dis Sci. 53(10):2784-8, 2008
                                                17. Gonzalez F et al: Extensive portal vein thrombosis related to abdominal trauma. Gastroenterol Clin Biol. 30(2):314-6, 2006
                                                18. Hidajat N et al: Imaging and radiological interventions of portal vein thrombosis. Acta Radiol. 46(4):336-43, 2005
                                                19. Okada T et al: Postoperative portal and splenic vein thrombosis in children: identification of risk factors. Pediatr Surg Int. 21(11):918-21, 2005
                                                20. Wang JT et al: Portal vein thrombosis. Hepatobiliary Pancreat Dis Int. 4(4):515-8, 2005
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Synonyms

                                                              • Portal vein thrombosis (PVT)
                                                            • Definitions

                                                              • Acute, chronic, or neoplastic occlusion of PV due to thrombosis or tumor invasion
                                                              • Chronic PV occlusion with numerous periportal collaterals is referred to as cavernous transformation

                                                            IMAGING

                                                            • General Features

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Angiographic Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Kwon JH et al: Diagnostic role of contrast-enhanced ultrasound in the discrimination of malignant portal vein thrombosis in patients with hepatocellular carcinoma. Anticancer Res. 40(8):4351-63, 2020
                                                                                              2. Zhao ZL et al: Imaging and pathological features of idiopathic portal hypertension and differential diagnosis from liver cirrhosis. Sci Rep. 10(1):2473, 2020
                                                                                              3. Gawande R et al: MRI in differentiating malignant versus benign portal vein thrombosis in patients with hepatocellular carcinoma: value of post contrast imaging with subtraction. Eur J Radiol. 118:88-95, 2019
                                                                                              4. Aumann EK et al: Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus. Abdom Radiol (NY). 43(9):2270-6, 2018
                                                                                              5. Jha RC et al: Portal vein thrombosis: imaging the spectrum of disease with an emphasis on MRI features. AJR Am J Roentgenol. 211(1):14-24, 2018
                                                                                              6. Tarantino L et al: Contrast-enhanced ultrasound in differentiating malignant from benign portal vein thrombosis in hepatocellular carcinoma. World J Gastroenterol. 21(32):9457-60, 2015
                                                                                              7. Girleanu I et al: Natural course of nonmalignant partial portal vein thrombosis in cirrhotic patients. Saudi J Gastroenterol. 20(5):288-92, 2014
                                                                                              8. Francoz C et al: Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol. 57(1):203-12, 2012
                                                                                              9. Gaba RC: Chemoembolization practice patterns and technical methods among interventional radiologists: results of an online survey. AJR Am J Roentgenol. 198(3):692-9, 2012
                                                                                              10. Maconi G et al: Portal vein thrombosis in inflammatory bowel diseases: a single-center case series. J Crohns Colitis. 6(3):362-7, 2012
                                                                                              11. Qi X et al: Degree of portal vein thrombosis might be associated with recanalization during anticoagulation. Clin Gastroenterol Hepatol. 10(7):820, 2012
                                                                                              12. Rodríguez-Castro KI et al: Optimal length of anticoagulant therapy in cirrhotic patients with portal vein thrombosis. Clin Gastroenterol Hepatol. 10(7):820-1, 2012
                                                                                              13. Senzolo M et al: Prospective evaluation of anticoagulation and transjugular intrahepatic portosistemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int. 32(6):919-27, 2012
                                                                                              14. Park DE et al: Chylous ascites caused by acute pancreatitis with portal vein thrombosis. J Korean Surg Soc. 81 Suppl 1:S64-8, 2011
                                                                                              15. Rossi S et al: Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol. 18(8):1749-56, 2008
                                                                                              16. Tublin ME et al: Altered liver morphology after portal vein thrombosis: not always cirrhosis. Dig Dis Sci. 53(10):2784-8, 2008
                                                                                              17. Gonzalez F et al: Extensive portal vein thrombosis related to abdominal trauma. Gastroenterol Clin Biol. 30(2):314-6, 2006
                                                                                              18. Hidajat N et al: Imaging and radiological interventions of portal vein thrombosis. Acta Radiol. 46(4):336-43, 2005
                                                                                              19. Okada T et al: Postoperative portal and splenic vein thrombosis in children: identification of risk factors. Pediatr Surg Int. 21(11):918-21, 2005
                                                                                              20. Wang JT et al: Portal vein thrombosis. Hepatobiliary Pancreat Dis Int. 4(4):515-8, 2005