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 == | ||
[[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 == | == Diagnostic Study of Choice == | ||
=== Gold standard/Study of choice: === | === Gold standard/Study of choice: === | ||
* Ultrasonography is the gold standard test for the diagnosis of portal vein thrombosis. | * [[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> | ||
* 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 ===== | ===== Diagnostic results ===== | ||
The | The [[ultrasonography]] is confirmatory of [[portal vein]] thrombosis: | ||
* Portal cavernoma (multiple tortuous small vessels replacing the portal vein) | * Portal cavernoma (multiple tortuous small vessels replacing the portal vein) | ||
* Absence or reduced flow in portal vein | * Absence or reduced flow in [[portal vein]] | ||
=== Diagnostic Criteria === | === 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> | *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> | ||
**Lack of vascularization of the thrombus on contrast-enhanced ultrasound(CEUS) | **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 mass-forming features of the [[thrombus]] on [[CT]] or [[MRI]] | ||
**Absence of disruption of the walls of veins on CT or MRI | **Absence of disruption of the walls of veins on [[CT]] or [[MRI]] | ||
**Absence of evidence of disruption of vessel walls | **Absence of evidence of disruption of vessel walls | ||
**No features of malignancy in a biopsy sample of the thrombus | **No features of malignancy in a biopsy sample of the [[thrombus]] | ||
**Stability or regression of the thrombus during follow-up | **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:<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> | |||
**Expansion of the involved vessel (vessel diameter > 1.8 cm) for the main [[portal vein]] | |||
**Tumor size >5 cm and distance <2 cm | |||
==References== | ==References== | ||
{{reflist|2}} | |||
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.