Obliteration of main portal vein with a portal cavernoma @Dr. Kuldeep Virani

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●Chronic portal vein thrombosis (PVT) may be asymptomatic and discovered incidentally when abdominal imaging is obtained for other reasons, or patients may present with symptoms related to portal hypertension or portal cholangiopathy, two of the complications of chronic PVT. Patients with chronic PVT may also develop intestinal ischemia and infarction if there is extension of the clot into the superior mesenteric vein, though the risk is small. Patients with chronic PVT may also have clinical manifestations related underlying conditions that predisposed to PVT, such as cirrhosis

●The management of chronic portal vein thrombosis (PVT) depends on the presence of predisposing conditions and the patient's comorbidities. Basic management includes screening for esophageal varices and treating complications of portal hypertension and portal cholangiopathy. In addition, anticoagulation may be indicated for some patients.

●Chronic portal vein thrombosis (PVT) is diagnosed with abdominal imaging. Our approach is to start with abdominal ultrasound with Doppler imaging, followed by a computed tomographic (CT) scan or magnetic resonance imaging (MRI) to confirm the diagnosis and to look for predisposing conditions, such as hepatocellular carcinoma.

●The primary considerations in the differential diagnosis of chronic portal vein thrombosis (PVT) are invasion of the portal vein by an abdominal malignancy (most frequently hepatocellular carcinoma) or, less often, constriction of the portal vein within a tumor (typically pancreatic cancer or cholangiocarcinoma). In addition, portal cavernomas may resemble cholangiocarcinoma or a pancreatic head mass on imaging studies.

Patients with chronic PVT develop collateral blood vessels that bring blood in a hepatopetal manner around the area of obstruction, known as cavernous transformation of the portal vein or portal cavernoma. When seen in a transverse section, as on a computed tomographic (CT) scan, cavernous transformation gives the appearance of multiple caveolar orifices

●Patients with PVT should be evaluated for conditions that may have predisposed to the development of the clot, such as prothrombotic states. While it is our practice to perform a hypercoagulability workup in all patients with PVT, including those with decompensated (Child C) cirrhosis, others would not perform the evaluation in patients with decompensated cirrhosis because of the high prevalence of PVT in this population.

●The goal of anticoagulation in patients with chronic PVT is to prevent recurrent thrombosis, prevent thrombus extension, and promote recanalization. However, while patients with chronic PVT are often at risk for recurrent thrombosis, they are also at risk for variceal bleeding. As a result, the decision to start anticoagulation must be made on a case-by-case basis.

no need of treatment if pt is asymptomatic.haemocystin mustbe observed.b12 n fa given