Portal vein thrombosis diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Ultrasonography is the gold standard test for the diagnosis of portal vein thrombosis.
Investigations:
- Among patients who present with clinical signs of absence or reduced flow in portal vein, the contrast enhanced ultrasound (CDUS) is the most specific test for the diagnosis.

The following result of ultrasonography is confirmatory of portal vein thrombosis:

Benign portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:^[1]^[2]
- 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:^[3]
- Expansion of the involved vessel (vessel diameter > 1.8 cm) for the main portal vein
- Tumor size >5 cm and distance <2 cm

↑ 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.