A 43-year-old woman with alcoholic hepatitis and new-onset ascites, for which paracentesis was performed. Ultrasound (unavailable) demonstrated portal vein thrombosis. MR was obtained some time later, in the course of evaluation for transplantation.
Ascities, hepatomegaly, elevated LFTs
Axial and coronal gadolinium enhanced GRE images of the liver demonstrate massive hepatomegaly and a moderate amount of ascites. The right portal vein does not fill with contrast. There is contrast in the umbilical vein within the falciform ligament. No other venous collaterals are identified. The spleen is not grossly enlarged.
1. Portal hypertension
a. Cirrhosis is the most common cause in the West;
b. Schistosomiasis is the most common cause world wide
a. Primary or secondary hepatic malignancy
b. Gastric carcinoma
c. Pancreatic carcinoma
3. Portal or mesenteric pyelophlebitis, associated with appendicitis or diverticulitis
4. Hypercoaguable states
5. Iatrogenic causes
a. Upper abdominal surgery
b. Endoscopic sclerotherapy
c. Hepatic transplantation
6. Inflammatory disorders
a. Crohn's disease
b. Ulcerative colitis
REFERENCE: Gore and Levine, Textbook of Gastrointestinal Radiology, pp. 1590-98, 1608-30, 1650-54.
Dx: Portal vein thrombosis and portal hypertension associated with alcoholic liver disease.
Dx Confirmed by:
Undergoing evaluation for transplantation
In this case, nodularity of the liver is not evident, and there is no gross splenomegaly. Enlargement of the liver is likely attributable to alcoholic hepatitis, and early cirrhosis is the likely cause of portal venous hypertension. The onset of ascites was a result of acute portal vein thrombosis.
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