A case of portal vein thrombosis by protein C and s deficiency completely recanalized by anticoagulation therapy

Abstract

Portal vein thrombosis (PVT) is a rare form of venous thrombosis that affects the hepatic portal vein flow, which can lead to portal hypertension. Treatment of PVT includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery, and liver transplantation. Single anticoagulation therapy is not regarded as a curative treatment but can be associated with a reduction in new thrombotic episodes. We experienced a case of acute total occlusion of PVT provoked by protein C and S deficiency syndrome. PVT was completely recanalized with oral anticoagulant therapy following low molecular weight heparin therapy.

Keywords: Anticoagulation; Protal vein; Protein C deficiency; Protein S deficiency; Thrombosis.

FIG. 1

Abdominal CT scan. (A) Ill-defined, flower-like, low attenuations can be found in the posterior segment of the liver (microabscess). (B) Massive intrahepatic portal vein thrombus and main portal vein thrombus can be found.

FIG. 2

Liver Doppler ultrasound. (A) The image shows the thrombus in the intrahepatic portal vein and the widening of the portal vein diameter. (B) There is echogenic material and flow in the right portal vein lumen and multiple collateral vessels are not shown on the porta hepatis. (C) There is no echogenic material in the right portal vein lumen and the flow can be observed. (D) The flow and Doppler wave are noted in the umbilical portion of the left portal vein.

FIG. 3

Abdominal CT scan 6 months after anticoagulation therapy. The portal vein thrombosis has disappeared completely.