Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment

Abstract

Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient's outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients' future prognoses.

Figure 1

Portal vein thrombosis. A: Complete thrombosis of the portal vein trunk (ultrasonography); B, C: Partial thrombosis of the right portal vein (ultrasonography and ultrasonography + doppler); D: Thrombosis of the right portal vein (CT scan); E, F: Thrombosis of the right portal vein (MRI).

Figure 2

Collateral circulation. A, B: Recanalization of paraumbilical vein (ultrasonography + doppler); C, D: Recanalization of paraumbilical vein (CT scan); E: Perigastric and paraesophageal varices (CT scan).

Figure 3

Cavernomatous transformation of the portal vein. A: Ultrasonography + doppler; B: CT scan.