Diagnosis Of Portal Vein Thrombosis Research Articles

Portal Vein Thrombosis in COVID-19: An Underdiagnosed Disease?

Background: Multiple studies have linked COVID-19 to a higher incidence of thromboembolic disorders. However, the association of COVID-19 with other potentially life-threatening complications, such as splanchnic vein thrombosis, is less well understood. This study aims to assess the prevalence, patient characteristics, clinical presentation, and outcomes of patients with portal vein thrombosis (PVT) and COVID-19. Methods: This was a retrospective observational study. From all positive patients for a reverse-transcription polymerase chain reaction (RT-PCR) swab test from March 2020 to June 2020, we included those who were older than 18 years, had received abdominal contrast-enhanced computed tomography (CT) in the 6 months following the positive RT-PCR swab, and had no previously known splanchnic vein thrombosis. Results: A total of 60 patients with abdominal CT were selected from all those positive for SARS-CoV-2 (n = 2987). The prevalence of PVT was 3/60 (5%). The mean age was 66.1 ± 16.5 years and 51.7% were male. In two of the three patients, there was no underlying pathology as a risk factor for PVT and one of them presented cirrhosis. The number of days from the start of COVID-19 symptoms until the PVT diagnosis were 21, 12, and 10 days. Anticoagulation treatment achieved recanalization in 100% of cases. During a mean follow-up of 803 days, none of the patients experienced long-term complications. Conclusions: Portal vein thrombosis is uncommon, and its incidence may be higher in COVID-19 patients. A greater understanding of the features of this disease in the context of COVID-19 could aid towards its diagnosis and allow for early detection and management.

Hereditary hemochromatosis as an independent predictor of portal vein thrombosis: national inpatient sample (2016-2020) analysis

Hereditary hemochromatosis is a common inherited metabolic disorder of iron metabolism with variable penetrance. Portal vein thrombosis has several well-known causes including cirrhosis, myeloproliferative neoplasm, inflammatory conditions of the abdomen, intra-abdominal malignancy, intra-abdominal surgery, and thrombophilia. It is unknown whether hereditary hemochromatosis is associated with portal vein thrombosis. Material and methodology. A retrospective analysis of the National Inpatient Sample database from 2016 to 2020 was conducted using International Classification of Diseases-10 codes to identify hospitalizations with portal vein thrombosis. We used multivariate regression analysis to calculate the adjusted odds ratio after controlling for age, gender, insurance type, Charlson Comorbidity Index, cirrhosis, myeloproliferative neoplasm, inflammatory conditions of the abdomen, intra-abdominal malignancy, intra-abdominal surgery, history of past thrombosis, thrombophilia, end-stage renal disease, obesity,smoking, and hyperlipidemia. Results. There were 25805 hospitalizations with primary diagnosis of portal vein thrombosis. Multivariate logistic regression showed that hereditary hemochromatosis was independently associated with portal vein thrombosis (Odds ratio= 4.7, 95% CI=1.15 to 19.35, p-value=0.03) when cirrhosis, myeloproliferative neoplasm, inflammatory conditions of the abdomen, intra-abdominal malignancy, history of thrombosis, history of abdominal surgery, history of thrombophilia, and end-stage renal disease among other factors were controlled.

Prevalence and Risk Factors for Portal Cavernoma in Adult Patients with Portal Vein Thrombosis.

Portal vein thrombosis (PVT) represents a restriction or occlusion of the portal vein by a blood clot, which can appear in liver cirrhosis, inherited or acquired thrombophilia, malignancies, abdominal infection, abdominal inflammation, and injury to the portal vein; it can evolve to local venous extension, recanalization, or portal cavernoma (PC). This research represents an observational study of patients admitted with a diagnosis of PVT between January 2018 and December 2022. We assessed the rate of and risk factors for PC. In total, 189 patients with PVT were included; the rate of PC was 14.8%. In univariate and multivariate analysis, the main risk factors for the presence of PC were etiology (thrombophilia, myeloproliferative disorders, local inflammatory diseases, and idiopathic causes), prior PVT, and complete versus incomplete or single-branch portal obstruction. In patients with superior mesenteric vein (SMV) thrombosis, distal obstruction was more prone to PC than proximal obstruction. The main predictive factors were etiology, prior PVT, complete PVT obstruction, and no prior non-selective beta-blocker (NSBB) use; in patients with SMV thrombosis, the distal extension was more significantly associated with the risk of PC. We propose a composite score for the prediction of PC which includes etiology, prior diagnosis of PVT, prior NSBB use, complete versus incomplete PVT, and distal versus proximal SMV thrombosis, with good accuracy (AUC 0.822) and an estimated sensitivity of 76.92% and specificity of 82.39% at a cut-off value of 4.

Portal Vein Thrombosis in Liver Cirrhosis. Part 1: Epidemiology, Pathogenesis, Clinic, Diag-nosis, Impact on Prognosis

Portal vein thrombosis is the most common thrombotic complication in patients with liver cirrhosis, especially in cases of severe forms. The pathogenesis is multifactorial in nature, it determined by a change in the balance between the coagulation and anticoagulation systems. Thrombosis is often asymptomatic and is accidentally detected, although it can be complicated by varicose bleeding, intestinal ischemia, and portal biliopathy. Ultrasound Doppler examination is a screening method, as an alternative, computed tomography and magnetic resonance imaging are used. The review highlights data on epidemiology, risk factors, clinical features, and diagnosis of portal vein thrombosis in patients with liver cirrhosis. The data on the effect of portal vein thrombosis on the progression of liver cirrhosis and the survival of patients, including after liver transplantation, are presented.

Predictive model for non-malignant portal vein thrombosis associated with cirrhosis based on inflammatory biomarkers.

Portal vein thrombosis (PVT), a complication of liver cirrhosis, is a major public health concern. PVT prediction is the most effective method for PVT diagnosis and treatment. To develop and validate a nomogram and network calculator based on clinical indicators to predict PVT in patients with cirrhosis. Patients with cirrhosis hospitalized between January 2016 and December 2021 at the First Hospital of Lanzhou University were screened and 643 patients with cirrhosis who met the eligibility criteria were retrieved. Following a 1:1 propensity score matching 572 patients with cirrhosis were screened, and relevant clinical data were collected. PVT risk factors were identified using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis. Variance inflation factors and correlation matrix plots were used to analyze multicollinearity among the variables. A nomogram was constructed to predict the probability of PVT based on independent risk factors for PVT, and its predictive performance was verified using a receiver operating characteristic curve (ROC), calibration curves, and decision curve analysis (DCA). Finally, a network calculator was constructed based on the nomograms. This study enrolled 286 cirrhosis patients with PVT and 286 without PVT. LASSO analysis revealed 13 variables as strongly associated with PVT occurrence. Multivariate logistic regression analysis revealed nine indicators as independent PVT risk factors, including etiology, ascites, gastroesophageal varices, platelet count, D-dimer, portal vein diameter, portal vein velocity, aspartate transaminase to neutrophil ratio index, and platelet-to-lymphocyte ratio. LASSO and correlation matrix plot results revealed no significant multicollinearity or correlation among the variables. A nomogram was constructed based on the screened independent risk factors. The nomogram had excellent predictive performance, with an area under the ROC curve of 0.821 and 0.829 in the training and testing groups, respectively. Calibration curves and DCA revealed its good clinical performance. Finally, the optimal cutoff value for the total nomogram score was 0.513. The sensitivity and specificity of the optimal cutoff values were 0.822 and 0.706, respectively. A nomogram for predicting PVT occurrence was successfully developed and validated, and a network calculator was constructed. This can enable clinicians to rapidly and easily identify high PVT risk groups.

Portal Vein Thrombosis: State-of-the-Art Review.

Background: Portal vein thrombosis (PVT) is a rare disease with an estimated incidence of 2 to 4 cases per 100,000 inhabitants. The most common predisposing conditions for PVT are chronic liver diseases (cirrhosis), primary or secondary hepatobiliary malignancy, major infectious or inflammatory abdominal disease, or myeloproliferative disorders. Methods: PVT can be classified on the basis of the anatomical site, the degree of venous occlusion, and the timing and type of presentation. The main differential diagnosis of PVT, both acute and chronic, is malignant portal vein invasion, most frequently by hepatocarcinoma, or constriction (typically by pancreatic cancer or cholangiocarcinoma). Results: The management of PVT is based on anticoagulation and the treatment of predisposing conditions. The aim of anticoagulation in acute thrombosis is to prevent the extension of the clot and enable the recanalization of the vein to avoid the development of complications, such as intestinal infarction and portal hypertension. Conclusions: The treatment with anticoagulant therapy favors the reduction of portal hypertension, and this allows for a decrease in the risk of bleeding, especially in patients with esophageal varices. The anticoagulant treatment is generally recommended for at least three to six months. Prosecution of anticoagulation is advised until recanalization or lifelong if the patient has an underlying permanent pro-coagulant condition that cannot be corrected or if there is thrombosis extending to the mesenteric veins.

Diagnostic Prediction of portal vein thrombosis in chronic cirrhosis patients using data-driven precision medicine model.

Portal vein thrombosis (PVT) is a significant issue in cirrhotic patients, necessitating early detection. This study aims to develop a data-driven predictive model for PVT diagnosis in chronic hepatitis liver cirrhosis patients. We employed data from a total of 816 chronic cirrhosis patients with PVT, divided into the Lanzhou cohort (n = 468) for training and the Jilin cohort (n = 348) for validation. This dataset encompassed a wide range of variables, including general characteristics, blood parameters, ultrasonography findings and cirrhosis grading. To build our predictive model, we employed a sophisticated stacking approach, which included Support Vector Machine (SVM), Naïve Bayes and Quadratic Discriminant Analysis (QDA). In the Lanzhou cohort, SVM and Naïve Bayes classifiers effectively classified PVT cases from non-PVT cases, among the top features of which seven were shared: Portal Velocity (PV), Prothrombin Time (PT), Portal Vein Diameter (PVD), Prothrombin Time Activity (PTA), Activated Partial Thromboplastin Time (APTT), age and Child-Pugh score (CPS). The QDA model, trained based on the seven shared features on the Lanzhou cohort and validated on the Jilin cohort, demonstrated significant differentiation between PVT and non-PVT cases (AUROC = 0.73 and AUROC = 0.86, respectively). Subsequently, comparative analysis showed that our QDA model outperformed several other machine learning methods. Our study presents a comprehensive data-driven model for PVT diagnosis in cirrhotic patients, enhancing clinical decision-making. The SVM-Naïve Bayes-QDA model offers a precise approach to managing PVT in this population.

The effect of splenic vein diameter on the diagnosis of portal vein thrombosis.

It was still controversial that whether the increase of splenic vein (SV) diameter increased the risk of portal vein thrombosis (PVT), which was a severe disease with high mortality, in the clinic. This study, using computational fluid dynamics method, aimed to investigate how the increase of SV diameter affects the portal vein hemodynamics under different anatomical and geometric features of the portal venous system, thus how it induced to PVT. The ideal models of the portal system, including different anatomical structures according to the location of left gastric vein (LGV) and inferior mesenteric vein (IMV), and different geometric morphological parameters models were established to carry out numerical simulation in this study. In addition, the morphological parameters of real patients were measured to verify the numerical simulation results. First, the wall shear stress (WSS) and helicity intensity, which were closely related to the occurrence of thrombosis, gradually decreased with the increase of SV diameter in all models. However, the degree of decrease was bigger in following models: (1) the models with LGV and IMV linking to SV compared with them linking to PV; (2) the models with big angle of PV and SV compared with small angle. In addition, the morbidity of PVT was higher when LGV and IMV linked to SV rather than them linked to PV in the real patients. Moreover, the angle of PV and SV was also different between PVT and non-PVT patients (125.53°±16.90° vs. 115.03°±16.10°, p=0.01). Whether the increase of SV diameter will result in PVT is depended on the anatomical structure of portal system and the angle between PV and SV, this is also the reason leading to the clinical controversy that the increase of SV diameter is the risk factor of PVT.

Presence of Hepatocellular Carcinoma Does Not Affect Course and Response to Anticoagulation of Bland Portal Vein Thrombosis in Cirrhotic Patients.

Malignancies are generally considered a risk factor for deep vein thrombosis and may hamper the recanalisation of thrombosed veins. We investigate whether the natural course and response to anticoagulant treatment of bland portal vein thrombosis (PVT) in patients with cirrhosis complicated by hepatocellular carcinoma (HCC) differ from those without HCC. Retrospective study in two hepatology referral centres, in Italy and Romania where patients with a diagnosis of PVT on cirrhosis and follow-up of at least 3 months with repeated imaging were included. A total of 162 patients with PVT and matching inclusion and exclusion criteria were identified: 30 with HCC were compared to 132 without HCC. Etiologies, Child-Pugh Score (7 vs 7) and MELD scores (11 vs 12, p=0.3679) did not differ. Anticoagulation was administered to 43% HCC vs 42% nonHCC. The extension of PVT in the main portal trunk was similar: partial/total involvement was 73.3/6.7% in HCC vs 67.4/6.1% in nonHCC, p=0.760. The remainder had intrahepatic PVT. The recanalization rate was 61.5% and 60.7% in HCC/nonHCC in anticoagulated patients (p=1). Overall PVT recanalisation, including treated and untreated patients, was observed in 30% of HCC vs 37.9% of nonHCC, p=0.530. Major bleeding incidence was almost identical (3.3% vs 3.8%, p=1). Progression of PVT after stopping anticoagulation did not differ (10% vs 15.9%, respectively, HCC/nHCC, p=0.109). The course of bland non-malignant PVT in cirrhosis is not affected by the presence of active HCC. Treatment with anticoagulation in patients with active HCC is safe and as effective as in nonHCC patients, this can potentially allow us to use otherwise contraindicated therapies (ie TACE) if a complete recanalization is achieved with anticoagulation.

Evaluation of Low-Molecular-Weight Heparin for Treatment of Portal Vein Thrombosis in Liver Cirrhosis Patients

Background and Objectives: Even though low-molecular-weight heparin (LMWH), including dalteparin, has a critical role in portal vein thrombosis (PVT) treatment in liver cirrhosis (LC) patients, the predictive factors and the proper dose of dalteparin for PVT treatment and relapse have not yet been investigated. Materials and Methods: This retrospective study evaluated the records of LC patients receiving dalteparin from July 2013 to June 2019. The odds ratio (OR) and adjusted OR were calculated from univariate and multivariable analyses, respectively. Results: Among data from 121 patients, the overall recanalization rate of all patients was 66.1% (80 patients). No history of variceal bleeding (OR 4.6, 95% CI: 1.88-11.43) and the case of newly developed thrombus before dalteparin treatment (OR 3.2, 95% CI: 1.24-8.08) were predictive factors associated with increased treatment response. Relapse of PVT occurred in 32 out of 80 patients (40%) who showed a recanalization. The risk of relapse was 3.1-3.9 times higher in those who took more than three months or more than six months from the diagnosis of PVT to dalteparin treatment compared to those who took less than these durations, respectively. In the dosing regimen, patients with the kg-based dosing regimen showed 2.6 times better response than those with the fixed dosing regimen. However, no difference in bleeding complications was observed. Conclusion: In the dosing regimen, the kg-based regimen that was the same as the venous thromboembolism regimen was a better option for the efficacy and safety of dalteparin therapy. Additionally, when treating PVT in LC patients, careful monitoring is recommended for patients with predictive factors for treatment response and relapse of PVT.

Treatment of portal vein thrombosis in cirrhosis: a multicenter real life cοhort study.

Portal vein thrombosis (PVT) is a common complication of cirrhosis and can be a cause or consequence of liver disease progression. It is unclear whether PVT treatment is affecting clinical outcomes in cirrhotics. This is a multicenter study of cirrhotics with PVT, initially retrospectively and thereafter prospectively registered in a data base. We studied the impact of PVT treatment on this population for efficacy, safety and the impact on survival. In survival analysis Mantel-Cox and Wilcoxon-Breslow-Gehan tests were used. A P value of <0.05, was considered significant. For statistical computations the STATA 12.1 was used. Seventy-six patients were included (76% decompensated, median MELD score 12 and Child-Pugh score 7), 47% with concomitant HCC. Fifty-one patients with PVT were treated with Vitamin-K antagonists or Low-Molecular-Weight Heparin. Patients were followed up for at least 6 months after PVT diagnosis, or until death or transplantation. PV patency after 6 months was not statistically different between patients receiving or not anticoagulation (complete-partial recanalization 27.4% of treated vs. 20% of untreated, P=0.21). Median survival was statistically worse between patients treated with anticoagulation than those untreated (10 vs. 15 months, P=0.036). Less portal hypertensive bleeding and less decompensation rates were found in treated cirrhotics vs. untreated (45.8% vs. 54.2%, P=0.003 and 78% vs. 80.9%, P=0.78, respectively). Patients with HCC had worse survival when treated vs. untreated (P=0.047). In our cohort of cirrhotics with PVT, treatment was feasible with acceptable side effects, but without meaningful clinical benefits.

Frequency of Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma

The hepatocellular carcinoma (HCC) is a frequent complication of liver. Portal vein thrombosis is common in HCC patients and associated with poor prognosis. But evidence lacks for local population. Objective: To assess the frequency of portal vein thrombosis in diagnosed patients of hepatocellular carcinoma presenting at DHQ hospital, Gujranwala. Methods: After permission from the ethical committee, this cross sectional study was done at the Department of Gastroenterology, DHQ hospital, Gujranwala from 19-03-2021 to 19-09-2021. Total 125 patients were selected from OPD. Informed consent was taken. All patients underwent Doppler ultrasound to diagnose the portal vein thrombosis. All data was analyzed in SPSS 22. Results: Total of 125 patients, 16.8 %( n=21) were in age group of 20-40 years and 83.2 %/(n=104) were in age group of 41-60 years. Mean age was 45.52+45.05 years. Distribution of size of hepatocellular carcinoma was 4.03+0.906 cm. There were 72.0 %( n=90) male whereas 28.0% (n=35) were females. According to the type of hepatocellular carcinoma, 64.8% (n=81) had naive and 35.2% (n=44) recurrent hepatocellular carcinoma. Total of 125 patients, 64.0% (n=80) had single and 36.0% (n=45) had multiple hepatocellular carcinoma. Frequency of portal vein thrombosis was 29.6% (n=37) in patients with hepatocellular carcinoma. Conclusions: We concluded that portal vein thrombosis is common in patients with HCC. An early diagnosis of Portal vein thrombosis along with the evaluation of the volume of portal vein thrombosis on CT and an early intervention is necessary.

Portal Interventions in the Setting of Venous Thrombosis or Occlusion.

Portal vein thrombosis most commonly occurs as a complication of liver cirrhosis and can result in worsening symptoms of portal hypertension, which often can be challenging to treat with conventional decompression therapies. In addition, because complete portal vein thrombosis is associated with higher posttransplant morbidity and mortality, it is regarded as a relative contraindication to liver transplant. Often, the diagnosis of portal vein thrombosis is incidental; hence, imaging remains the mainstay for diagnosing this complication and is used to guide subsequent treatment. Although anticoagulation is the initial approach used to treat acute portal vein thrombosis, endovascular and/or surgical interventions may be necessary when there is concern for impending bowel ischemia. Treatment of chronic portal vein thrombosis is primarily aimed at alleviating the symptoms of portal hypertension and improving the chance of candidacy for liver transplant. Awareness of the portal venous anatomy to differentiate it from the periportal collaterals is key during recanalization of a chronically occluded portal vein. The authors provide an overview of the pathophysiology, acute and chronic imaging findings, and management of portal vein thrombosis, with a specific focus on endovascular management, as well as a summary of the current related literature. An invited commentary by Lopera and Yamaguchi is available online. ©RSNA, 2022.

S3122 Portal Vein Thrombosis Post Laparoscopic Sleeve Gastrectomy

Introduction: Portal vein thrombosis (PVT) is a clot formation in one of the branches of the portal vein. It is a well-known complication in patients with cirrhosis or post-abdominal surgery. Data on PVT post laparoscopic bariatric surgeries are scarce. Here we present a case of PVT post laparoscopic sleeve gastrectomy. Case Description/Methods: A 43- years-old female with a known past medical history of hypertension, Asthma, and obesity underwent a robotic-assisted laparoscopic sleeve gastrectomy. She presented to the Emergency Department (ED) complaining of Abdominal pain 2 days after the sleeve gastrectomy operation. The patient reported doing well postoperatively till 2 days when she developed sudden epigastric abdominal pain and generalized abdominal discomfort, associated with nausea and anorexia. On arrival at the ED, her vital signs were stable and liver enzymes were normal. She had RUQ tenderness on the physical exam without guarding or rebound. The patient then had a Computed tomography (CT) of the abdomen and pelvis with IV contrast which showed occlusive left portal vein thrombosis extending to branches. She was started on oral direct Anticoagulant (DOAC) with Rivaroxaban. She had complete hypercoagulable work up with hematology which was unremarkable (Figure 1). Discussion: PVT is a well-described complication of cirrhosis. in non-cirrhotic patients, the etiology of PVT can be due to systemic or local factors. A hypercoagulable state such as Factor V Leiden, antithrombin III deficiency, protein C and S deficiency, or Methylenetetrahydrofolate reductase (MTHFR) mutation is associated with higher thrombosis risk. Local factors include direct manipulation of portosystemic vessels such as during splenectomy with resultant endothelial damage and increase vascular thrombogenicity. A gastric sleeve is less likely to cause PVT since it only involves the short gastric vein. However, with the use of laparoscopic surgical techniques, there has been an increase in reported PVT. It is suspected that an increase in intra-abdominal pressure during carbon dioxide insufflation causes a pro-thrombotic state by decreasing venous and portal blood flow. The diagnosis of PVT post-operatively requires a high level of suspicion and can be made with abdominal imaging such as Ultrasound with color doppler or CT with IV contrast. The treatment is usually anticoagulation with the goal of recanalization of the portal vein on repeat imaging to prevent the development of non-cirrhotic portal hypertension in these patients.Figure 1.: Color doppler showing left portal vein thrombosis.

Dual-Energy CT for the Detection of Portal Vein Thrombosis: Improved Diagnostic Performance Using Virtual Monoenergetic Reconstructions.

Purpose: To investigate the diagnostic performance of noise-optimized virtual monoenergetic images (VMI+) in dual-energy CT (DECT) of portal vein thrombosis (PVT) compared to standard reconstructions. Method: This retrospective, single-center study included 107 patients (68 men; mean age, 60.1 ± 10.7 years) with malignant or cirrhotic liver disease and suspected PVT who had undergone contrast-enhanced portal-phase DECT of the abdomen. Linearly blended (M_0.6) and virtual monoenergetic images were calculated using both standard VMI and noise-optimized VMI+ algorithms in 20 keV increments from 40 to 100 keV. Quantitative measurements were performed in the portal vein for objective contrast-to-noise ratio (CNR) calculation. The image series showing the greatest CNR were further assessed for subjective image quality and diagnostic accuracy of PVT detection by two blinded radiologists. Results: PVT was present in 38 subjects. VMI+ reconstructions at 40 keV revealed the best objective image quality (CNR, 9.6 ± 4.3) compared to all other image reconstructions (p < 0.01). In the standard VMI series, CNR peaked at 60 keV (CNR, 4.7 ± 2.1). Qualitative image parameters showed the highest image quality rating scores for the 60 keV VMI+ series (median, 4) (p ≤ 0.03). The greatest diagnostic accuracy for the diagnosis of PVT was found for the 40 keV VMI+ series (sensitivity, 96%; specificity, 96%) compared to M_0.6 images (sensitivity, 87%; specificity, 92%), 60 keV VMI (sensitivity, 87%; specificity, 97%), and 60 keV VMI+ reconstructions (sensitivity, 92%; specificity, 97%) (p ≤ 0.01). Conclusions: Low-keV VMI+ reconstructions resulted in significantly improved diagnostic performance for the detection of PVT compared to other DECT reconstruction algorithms.

PREVALENCE AND CHARACTERISTICS OF PORTAL VEIN RECANALIZATION IN CIRRHOTIC PATIENTS ADMITTED WITH PORTAL THROMBOSIS IN A THIRD LEVEL CARE CENTER

Portal vein thrombosis (PVT) refers to the formation of blood clots within the trunk of the portal vein (PV) or its main branches, which can spread to the superior mesenteric (SMV) and splenic (VE) veins. The natural history of liver cirrhosis is a complication with a "rebalanced" coagulation system that can promote bleeding or a thrombotic tendency. The prevalence in compensated cirrhotic is 1% in and 8-25% in decompensated patients. To determine the prevalence and characteristics of PV recanalization in cirrhotic patients with PVT. Descriptive, cross-sectional/prevalence. We reviewed medical records of all cirrhotic patients admitted with PVT diagnosis from January 2019 to April 2021. We included patients with a diagnosis of PVT. Qualitative variables were expressed as frequencies and percentages. The numerical variables were expressed as means and standard deviations. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate. Of 553 cirrhotic patients admitted from January 2019 to April 2021, 48(8.67%) patients with PVT diagnoses were included. Of these, 27(56.3%) were women, with a mean age of 59.37±12.67 years, 9(18%) with a diagnosis of cancer, of which 8(16.7%) were hepatocellular carcinoma, 2(33.3%) extended to the two arms, 6(12.5%) received treatment, 100% of the treatment was based on low molecular weight heparin. According to the degree of recanalization: 37(77.08%) recanalized, 27(56.3%) did so partially, of them, 24(88.9%) were spontaneous; 10(20.8%) recanalized utterly, of which 90% were without treatment, with no significant difference between recanalization to free progression vs. treatment ( p =0.179) and 11(22.9%) did not recanalize. Regarding the characteristics of the thrombosis by imaging studies, 26(54.2%) were chronic, 28(58%) partial, only 9(18.8%) with cavernomatous transformation, 30(62.5%) were located in the main trunk, 6(12.5%) extended to the SLM and 11(22.9%) presented flow <15cm/s. In cirrhotics with recent or partial occlusion (> 50% of the lumen) or thrombosis of the main PV or SMV, therapy should be considered. Anticoagulant or interventional therapy has no benefit complete chronic occlusion of the main PV or cavernomatous transformation. Spontaneous recanalization occurs in 40% in 3 months, and with therapy, it is 80%. Several cohort studies reported that near 50% recanalize partially or totally in the next three months, and up to 80% recanalize at 12 months. Clinical trial data are weak regarding the indications for treatment for PVT without ischemic symptoms. Our study showed that 77.08% of cirrhotic patients with PVT recanalized, most partially during follow-up and more than 80% spontaneously, and only a low percentage presented with cavernomatous transformation. In addition, more than 70% of the patients who recanalized have a low risk of re-thrombosis related to flow. The prevalence of PVT in cirrhotic patients was relatively low (10%), complete or partial recanalization was very high, even spontaneously, there was no difference in the degree of recanalization with or without anticoagulation. The authors declares that there is no conflict of interest

S3386 Occurrence of Portal Vein Thrombosis During the COVID-19 Pandemic Compared to Pre-COVID Time

Introduction: Portal vein thrombosis (PVT) is clinically important because it can lead to significant morbidity and mortality. However, early diagnosis and treatment can prevent long term complications. Increased incidence of venous and arterial thromboembolism has been reported in COVID-19. Nevertheless, there are only few case reports on portal vein thrombosis (PVT) in COVID-19 patients. Our aim was to investigate the occurrence of PVT during the COVID-19 pandemic compared to pre-COVID time. Methods: We conducted an Institutional Review Board (IRB) approved, retrospective, chart review study of PVT that diagnosed at four teaching hospitals in our health system from 3/11/18 till 3/11/21. Data were extracted using I81 ICD 10 code for PVT. We compared the occurrence of PVT from 3/11/20 when COVID-19 pandemic was declared by WHO, to the previous years of 2019 and 2018. The COVID-19 status of the patients diagnosed with PVT after 3/11/20 was determined by either positive SARS-CoV-2 PCR or positive COVID-19 antibody test prior to the PVT diagnosis. Results: The number of patients diagnosed with PVT between 3/11/20 and 3/11/21 was 172, compared to 210 of 2019 and 240 of 2018. The demographics of the patients were similar with an average age of 61+/-15 vs 63+/-15 vs 61+/-15.8 years. About 30% of the patients had known liver cirrhosis at the time of PVT diagnosis in each year. Sixteen out of the 172 patients (9.3%) between 3/11/20 and 3/11/21 had COVID-19 prior to the PVT diagnosis. Out of the 16, only 8 patients had positive PCR during or prior to the PVT, and 8 patients had suspected COVID-19 history based on their positive antibody test without vaccination. Seven out of the 16 COVID-19 patients (43.75%) had also underlying cirrhosis prior to the diagnosis of PVT. Conclusion: Our study showed that the occurrence of PVT during the COVID-19 pandemic, between 3/11/20 and 3/11/21, was lower compared to previous years. This may be partly resulted from the lack of testing in critically ill COVID-19 patients, or in asymptomatic PVT patients, or due to the limited access. The lower detection rate has concerns for delay in diagnosis of PVT which may have significant impact on its outcome and long term complications. Further studies are warranted to determine whether COVID-19 in cirrhotic patients increases the risk of PVT during or after the infection and benefit from closer monitoring post infection.

Evolution of Nonmalignant Portal Vein Thrombosis in Liver Cirrhosis: A Pictorial Review.

Portal vein thrombosis (PVT) is a common complication in liver cirrhosis, especially in advanced cirrhosis. It may be related to a higher risk of liver-related events and liver function deterioration. Imaging examinations can not only provide an accurate diagnosis of PVT, such as the extent of thrombus involvement and the degree of lumen occupied, but also identify the nature of thrombus (i.e., benign/malignant and acute/chronic). Evolution of PVT, mainly including development, recanalization, progression, stability, and recurrence, could also be assessed based on the imaging examinations. This article briefly reviews the pathophysiology, diagnosis, classification, and evolution of PVT with an emphasis on their computed tomography imaging features.

Клінічний випадок: діагностика тромбозу ворітної вени з успішним лікуванням та наступним трирічним спостереженням

Стаття присвячена клінічному спостереженню позапечінкової портальної гіпертензії внаслідок тромбозу ворітної вени, що вперше проявилася кровотечею з варикозно розширених вен стравоходу та шлунка, у молодої пацієнтки. Особливості анамнезу, клінічної картини вказували на безсимптомний перебіг захворювання до моменту катастрофи. Складність ведення таких хворих пов’язана з недостатньою інформативністю рутинних методів дослідження, необхідністю застосування спеціальних методів дослі­дження для встановлення діагнозу та нестандартних методів лікування. Проаналізовано дані лабораторно-інструментальних методів дослідження в даної хворої, наведено сучасний діагностичний пошук причин захворювання печінки та синдрому портальної гіпертензії в реальних умовах. Виявлена відсутність ознак гепатиту, а оцінка стану печінки за допомогою еластометрії виключила наявність фіброзу в цієї хворої. Встановлений діагноз позапечінкової портальної гіпертензії, і хвора спрямована на оперативне лікування. В Інституті хірургії та трансплантології проведено успішну шунтуючу операцію. Далі встановлена позитивна динаміка клінічних даних, спленомегалії, що давала больовий синдром та явища гіперспленізму. Описано консервативне лікування синдрому портальної гіпертензії та симптоматичне лікування хворої, що застосовувалось. Обґрунтована необхідність індивідуального вибору рухового режиму та медикаментозного ведення, що включає урсодезоксихолеву кислоту. За 3 роки у хворої спостерігається значне зменшення портальної гіпертензії при збереженні паренхіми печінки, що дає надію на позитивні віддалені результати.

Delayed Diagnosis of Portal Vein Thrombosis Due to Premature Closure of Cholecystitis

A 77-year-old woman presented to our hospital with anorexia. One month prior to admission she began to lose her appetite and showed weight loss of more than 5 kg, so she visited a nearby clinic. A blood test found no abnormalities, other than a mildly high C-reactive protein level of unknown cause. Her symptoms did not improve, and she was referred to our hospital. At the time of her visit, the patient had no fever or abdominal pain.