A large portal vein: a rare finding of recent portal vein thrombosis

Prognostic factors in non-malignant and non-cirrhotic patients with portal cavernoma: An 8-year retrospective single-center study

AIM: To evaluate the outcome of non-malignant and non-cirrhotic patients with portal cavernoma and to determine the predictors for survival.

METHODS: Between July 2002 and June 2010, we retrospectively enrolled all consecutive patients admitted to our department with a diagnosis of portal cavernoma without abdominal malignancy or liver cirrhosis. The primary endpoint of this observational study was death and cause of death. Independent predictors of survival were identified using the Cox regression model.

RESULTS: A total of 64 patients were enrolled in the study. During a mean follow-up period of 18 ± 2.41 mo, 7 patients died. Causes of death were pulmonary embolism (n = 1), acute leukemia (n = 1), massive esophageal variceal hemorrhage (n = 1), progressive liver failure (n = 2), severe systemic infection secondary to multiple liver abscesses (n = 1) and accident (n = 1). The cumulative 6-, 12- and 36-mo survival rates were 94.9%, 86% and 86%, respectively. Multivariate Cox regression analysis demonstrated that the presence of ascites (HR = 10.729, 95%CI: 1.209-95.183, P = 0.033) and elevated white blood cell count (HR = 1.072, 95%CI: 1.014-1.133, P = 0.015) were independent prognostic factors of non-malignant and non-cirrhotic patients with portal cavernoma. The cumulative 6-, 12- and 36-mo survival rates were significantly different between patients with and without ascites (90%, 61.5% and 61.5% vs 97.3%, 97.3% and 97.3%, respectively, P = 0.0008).

CONCLUSION: The presence of ascites and elevated white blood cell count were significantly associated with poor prognosis in non-malignant and non-cirrhotic patients with portal cavernoma.

CT features of non-malignant portal vein thrombosis: a pictorial review

Portal vein thrombosis (PVT) is a rare clinical entity in general population, but a relatively frequent entity in liver cirrhosis. Severe PVT-related complications are potentially lethal, such as ischemic intestinal infarction and complications of portal hypertension. Additionally, occlusive PVT can not only increase the incidence of variceal rebleeding, but also significantly decrease the cirrhotic patients' survival. Based on the clinical significance of PVT, early diagnosis is very critical to allow for rapid establishment of appropriate treatment and improvement of prognosis. Dynamic CT scan is an important diagnostic modality of PVT. The objective of this pictorial review is to illustrate various CT features of non-malignant portal vein thrombosis and its associated abnormalities. Evolution of portal vein thrombosis, such as stage, degree, and extension of thrombus, can be evaluated according to CT demonstrations, which is helpful to timely adopt appropriate treatment modality. Other associated CT findings include the dilation of collateral veins around the obstructed portion of portal vein and the hepatic perfusion and morphology abnormalities.

Transjugular intrahepatic portosystemic shunt for portal cavernoma with symptomatic portal hypertension in non-cirrhotic patients

BACKGROUND

Portal cavernoma is regarded as a contraindication to transjugular intrahepatic portosystemic shunt (TIPS).

AIM

To evaluate the feasibility, safety, and efficacy of TIPS for symptomatic portal hypertension in non-cirrhotic patients with portal cavernoma.

METHODS

Between July 2002 and December 2009, 46 consecutive non-cirrhotic patients with portal cavernoma were admitted to our center. Twenty patients presented with variceal rebleeding (n = 20) and refractory ascites (n = 1), and were treated with TIPS. They were followed until either death or July 2010. Data were compared using the Fisher's exact test or t test.

RESULTS

TIPS were successfully placed in 35% (7/20) of patients via a transjugular approach alone (n = 1), a combined transjugular/transhepatic approach (n = 4), and a combined transjugular/transsplenic approach (n = 2). TIPS were inserted in a large collateral vein in two patients in whom recanalization of the occluded main portal vein was impossible. Procedure-related complication was hepatic capsule perforation in one patient who was cured by medical therapy alone. Shunt dysfunction occurred in two patients, but TIPS revision was failed in one of them. Portosystemic pressure gradient was significantly reduced in TIPS success group (26.3 ± 1.1 vs. 12.4 ± 1.1 mmHg, p < 0.001). The incidence of variceal bleeding in TIPS success group is lower than that in TIPS failure group (14 vs. 69%, p = 0.057). In TIPS success group, two patients died of systemic infection and accident, respectively. In TIPS failure group, two patients died of liver failure.

CONCLUSIONS

TIPS procedures are feasible and safe in selected patients with portal cavernoma. Successful TIPS insertions may decrease the incidence of variceal rebleeding.