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Portal vein thrombosis, incidental PM finding. Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. The mortality rate is approximately 1 in 10. [1]
A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [18] On Doppler ultrasonography , a slow velocity of <16 cm/s in addition to dilatation in the main portal vein are diagnostic of portal hypertension. [ 19 ]
Doppler ultrasound of the liver is typically utilized to confirm or suggest the diagnosis. Common findings on liver doppler ultrasound include increased phasicity of portal veins with eventual development of portal flow reversal. The liver is usually enlarged but maintained normal echogenicity. A liver biopsy is required for a definitive diagnosis.
This leads to increased portal vein and hepatic sinusoid pressures as the blood flow stagnates. The increased portal pressure causes increased filtration of vascular fluid with the formation of ascites in the abdomen and collateral venous flow through alternative veins leading to esophageal, gastric and rectal varices.
Liver cirrhosis can lead to increased intrahepatic vascular resistance and vasodilation of portal system arteries, both of which increase pressure in the portal vein. [4] Color Doppler Ultrasound is the most useful imaging tool used to identify aneurysms, thrombosis, and branching patterns of the portal venous system, and to determine if ...
hepatic portal vein (entering) The hepatic duct lies in front and to the right, the hepatic artery to the left, and the portal vein behind and between the duct and artery. It also transmits nerves and lymphatics. Sympathetic nerves - these provide afferent pain impulses from the liver and gall bladder to the brain.
Caput medusae is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. The name caput medusae (Latin for "head of Medusa") originates from the apparent similarity to Medusa's head, which had venomous snakes in place of hair.
A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [8] On Doppler ultrasonography , the main portal vein (MPV) peak systolic velocity normally ranges between 20 cm/s and 40 cm/s. [ 9 ]