Abstract
Splanchnic vein thrombosis (SVT) is a broad term that includes Budd-Chiari syndrome and occlusion of veins that constitute the portal venous system. Due to the common risk factors involved in the pathogenesis of these clinically distinct disorders, concurrent involvement of two different regions is quite common. In acute and subacute SVT, the symptoms may overlap with a variety of other abdominal emergencies while in chronic SVT, the extent of portal hypertension and its attendant complications determine the clinical course. As a result, clinical diagnosis is often difficult and is frequently reliant on imaging. Tremendous improvements in vascular imaging in recent years have ensured that this once rare entity is being increasingly detected. Treatment of acute SVT requires immediate anticoagulation. Transcatheter thrombolysis or transjugular intrahepatic portosystemic shunt is used in the event of clinical deterioration. In cases with peritonitis, immediate laparotomy and bowel resection may be required for irreversible bowel ischemia. In chronic SVT, the underlying cause should be identified and treated. The imaging manifestations of the clinical syndromes resulting from SVT are comprehensively discussed here along with a brief review of the relevant clinical features and therapeutic approach.
Highlights
Splanchnic venous system includes the mesenteric, splenic, and hepatic beds, the first two serving as the major inflow for the third (Figure 1)
Blood flowing through the intestines, spleen, and pancreas is collected by the superior mesenteric vein (SMV) and splenic vein (SV) which join to form the portal vein (PV)
Venous outflow from the liver is through the hepatic veins (HV) which drain into the inferior vena cava (IVC)
Summary
Splanchnic venous system includes the mesenteric, splenic, and hepatic beds, the first two serving as the major inflow for the third (Figure 1). Blood flowing through the intestines, spleen, and pancreas is collected by the superior mesenteric vein (SMV) and splenic vein (SV) which join to form the portal vein (PV). Stomach and part of the pancreas drain directly into the portal vein. Venous outflow from the liver is through the hepatic veins (HV) which drain into the inferior vena cava (IVC). The term splanchnic vein thrombosis (SVT) includes occlusion of veins that form the portal venous system or the hepatic veins (Budd-Chiari syndrome) [1, 2]. Portal and mesenteric vein thrombosis and Budd-Chiari syndrome are three distinct clinical entities, their etiologies are often shared and clinical presentation may overlap. The present review appraises the radiological manifestations of SVT and aims to underscore the importance of imaging in decision making and patient selection to improve therapy and outcome in this group of patients
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