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Case of the Month

April 2008

Patient Data: 71 year old male

Clinical Info: Weight loss and abnormal liver function tests

Transverse image of the left portal vein with an intraluminal structure

Detail of the liver contour showing an irregular liver contour

Another image of the liver showing an intraluminal structure in the portal vein and an irregular liver contour

Detail of the portal vein shows no normal intraluminal flow, but color doppler signals suggestive of flow in the intraluminal mass

e- flow image of the portal vein also suggestive of flow in the intraluminal portal mass. The rest of the liver parenchyma was diffuse inhomogeneous, but no circumscribed tumor could be found. A CT scan was recommended.

CT image of the same patient arterial phase

CT image of the same patient portal phase The CT scan confirmed the irregular inhomogeneous aspect of the liver, but was not conclusive about the presence of a tumor or tumor vascularity in the portal veins. Because the initial ultrasound examination was very suggestive for a tumor thrombus in the portal veins, we decided to perform a contrast study using Sonovue as contrast.

366.swf The cineloop clearly shows contrast enhancement in the intraluminal mass very suggestive of an extensive tumor thrombus in the portal veins. A biopsy to confirm the diagnosis was discussed but not performed.

The patient's condition deteriorated rapidly and he died a few weeks later. An autopsy was performed.
At autopsy a cirrhotic liver was found. In the portal veins a diffuse growing hepatocellular carcinoma was found.

For more cases of portal vein thrombosis (tumoral and non tumoral) see

Rossi S, Rosa L, Ravetta V, Cascina A, Quaretti P, Azzaretti A, Scagnelli P, Tinelli C, Dionigi P, Calliada F. Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous systems.
AJR Am J Roentgenol. 2006 Mar;186(3):763-73.

Tarantino L, Francica G, Sordelli I, Esposito F, Giorgio A, Sorrentino P, de Stefano G, Di Sarno A, Ferraioli G, Sperlongano P. Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsyAbdom Imaging. 2006 Sep-Oct;31(5):537-44.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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