Portal vein thrombosis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Portal vein thrombosis}}
{{Portal vein thrombosis}}
{{CMG}} {{AE}}
{{CMG}} {{AE}}{{F.K}} [mailto:fkahe@bidmc.harvard.edu] [mailto:fkahe@bidmc.harvard.edu] [mailto:fkahe@bidmc.harvard.edu] [mailto:fkahe@bidmc.harvard.edu]


== Overview ==
== Overview ==
* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
[[Ultrasonography]] is the gold standard test for the diagnosis of portal vein thrombosis. The following result of [[ultrasonography]] include: Portal cavernoma (multiple tortuous small vessels replacing the portal vein) and absence or reduced flow in [[portal vein]] is confirmatory of portal vein thrombosis.
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].  
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
* Remember to create links within WikiDoc by placing <nowiki>[[square brackets]]</nowiki> around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example, if a sentence contained the phrase anterior spinal artery syndrome, the link should be to [[anterior spinal artery syndrome]] not [[anterior]] or [[artery]] or [[syndrome]].  For more information on how to create links, click [[here]].
* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
===== Template statements =====


=== Gold standard/Study of choice: ===
=== Gold standard/Study of choice: ===
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* [[Ultrasonography]] is the gold standard test for the diagnosis of [[portal vein]] thrombosis.<ref name="pmid25941431">{{cite journal |vauthors=Chawla YK, Bodh V |title=Portal vein thrombosis |journal=J Clin Exp Hepatol |volume=5 |issue=1 |pages=22–40 |year=2015 |pmid=25941431 |pmc=4415192 |doi=10.1016/j.jceh.2014.12.008 |url=}}</ref>
* The following result of [gold standard test] is confirmatory of [disease name]:
* Among patients who present with clinical signs of absence or reduced flow in [[portal vein]], the contrast enhanced ultrasound (CEUS) is the most specific test for the diagnosis.
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison table for diagnostic studies of choice for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
The [[ultrasonography]] is confirmatory of [[portal vein]] thrombosis:
* Result 1
* Portal cavernoma (multiple tortuous small vessels replacing the portal vein)
* Result 2
* Absence or reduced flow in [[portal vein]]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Benign [[portal vein]] thrombosis may be diagnosed at any time if one or more of the following criteria are met:<ref name="PiscagliaGianstefani2010">{{cite journal|last1=Piscaglia|first1=Fabio|last2=Gianstefani|first2=Alice|last3=Ravaioli|first3=Matteo|last4=Golfieri|first4=Rita|last5=Cappelli|first5=Alberta|last6=Giampalma|first6=Emanuela|last7=Sagrini|first7=Elisabetta|last8=Imbriaco|first8=Grazia|last9=Pinna|first9=Antonio Daniele|last10=Bolondi|first10=Luigi|title=Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinom for liver transplantation|journal=Liver Transplantation|year=2010|pages=NA–NA|issn=15276465|doi=10.1002/lt.22044}}</ref><ref name="pmid19032223">{{cite journal |vauthors=Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D'Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD |title=Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria |journal=Am. J. Transplant. |volume=8 |issue=12 |pages=2547–57 |year=2008 |pmid=19032223 |doi=10.1111/j.1600-6143.2008.02409.x |url=}}</ref>
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
**Lack of vascularization of the thrombus on contrast-enhanced ultrasound (CEUS)
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
**Absence of mass-forming features of the [[thrombus]] on [[CT]] or [[MRI]]
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
**Absence of disruption of the walls of veins on [[CT]] or [[MRI]]
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
**Absence of evidence of disruption of vessel walls
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
**No features of malignancy in a biopsy sample of the [[thrombus]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
**Stability or regression of the thrombus during follow-up
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
*Malignant portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:<ref name="OsmanSamy2016">{{cite journal|last1=Osman|first1=Nasr Mohamed Mohamed|last2=Samy|first2=Laila Adel Mohamed|title=Benign and malignant portal venous thrombosis: Multi-modality imaging evaluation|journal=The Egyptian Journal of Radiology and Nuclear Medicine|volume=47|issue=2|year=2016|pages=387–397|issn=0378603X|doi=10.1016/j.ejrnm.2016.02.010}}</ref>
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
**Expansion of the involved vessel (vessel diameter > 1.8 cm) for the main [[portal vein]]
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
**Tumor size >5 cm and distance <2 cm
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].
 


==References==
==References==
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
{{reflist|2}}
* For information on how to add references into your page, click [[Adding References to Articles|here]].

Latest revision as of 14:33, 29 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2] [3] [4] [5] [6]

Overview

Ultrasonography is the gold standard test for the diagnosis of portal vein thrombosis. The following result of ultrasonography include: Portal cavernoma (multiple tortuous small vessels replacing the portal vein) and absence or reduced flow in portal vein is confirmatory of portal vein thrombosis.

Diagnostic Study of Choice

Gold standard/Study of choice:

  • Ultrasonography is the gold standard test for the diagnosis of portal vein thrombosis.[1]
  • Among patients who present with clinical signs of absence or reduced flow in portal vein, the contrast enhanced ultrasound (CEUS) is the most specific test for the diagnosis.
Diagnostic results

The ultrasonography is confirmatory of portal vein thrombosis:

  • Portal cavernoma (multiple tortuous small vessels replacing the portal vein)
  • Absence or reduced flow in portal vein

Diagnostic Criteria

  • Benign portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:[2][3]
    • Lack of vascularization of the thrombus on contrast-enhanced ultrasound (CEUS)
    • Absence of mass-forming features of the thrombus on CT or MRI
    • Absence of disruption of the walls of veins on CT or MRI
    • Absence of evidence of disruption of vessel walls
    • No features of malignancy in a biopsy sample of the thrombus
    • Stability or regression of the thrombus during follow-up
  • Malignant portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:[4]
    • Expansion of the involved vessel (vessel diameter > 1.8 cm) for the main portal vein
    • Tumor size >5 cm and distance <2 cm

References

  1. ↑ Chawla YK, Bodh V (2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
  2. ↑ Piscaglia, Fabio; Gianstefani, Alice; Ravaioli, Matteo; Golfieri, Rita; Cappelli, Alberta; Giampalma, Emanuela; Sagrini, Elisabetta; Imbriaco, Grazia; Pinna, Antonio Daniele; Bolondi, Luigi (2010). "Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinom for liver transplantation". Liver Transplantation: NA–NA. doi:10.1002/lt.22044. ISSN 1527-6465.
  3. ↑ Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D'Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD (2008). "Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria". Am. J. Transplant. 8 (12): 2547–57. doi:10.1111/j.1600-6143.2008.02409.x. PMID 19032223.
  4. ↑ Osman, Nasr Mohamed Mohamed; Samy, Laila Adel Mohamed (2016). "Benign and malignant portal venous thrombosis: Multi-modality imaging evaluation". The Egyptian Journal of Radiology and Nuclear Medicine. 47 (2): 387–397. doi:10.1016/j.ejrnm.2016.02.010. ISSN 0378-603X.
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