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. 2014 Nov 13;9(11):e112501.
doi: 10.1371/journal.pone.0112501. eCollection 2014.

Rational classification of portal vein thrombosis and its clinical significance

Jingqin Ma  1 , Zhiping Yan  1 , Jianjun Luo  1 , Qingxin Liu  1 , Jianhua Wang  1 , Shijing Qiu  2
Affiliations

Rational classification of portal vein thrombosis and its clinical significance

Jingqin Ma et al. PLoS One. .

Abstract

Portal vein thrombosis (PVT) is commonly classified into acute (symptom duration <60 days and absence of portal carvernoma and portal hypertension) and chronic types. However, the rationality of this classification has received little attention. In this study, 60 patients (40 men and 20 women) with PVT were examined using contrast-enhanced computed tomography (CT). The percentage of vein occlusion, including portal vein (PV) and superior mesenteric vein (SMV), was measured on CT image. Of 60 patients, 17 (28.3%) met the criterion of acute PVT. Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001). However, there was no significant difference in PV occlusion between patients with and without symptoms. The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001). Complications of portal hypertension were significantly associated with cirrhosis (p<0.001) rather than with the severity of PVT and presence of cavernoma. These results suggest that the severity of PVT is only associated with the formation of portal cavernoma but unrelated to the onset of symptoms and the development of portal hypertension. We classified PVT into complete and partial types, and each was subclassified into with and without portal cavernoma. In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT. The new classification system can determine the pathological alterations of PVT, patency of portal vein and outcome of treatment in a longitudinal study.

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Conflict of interest statement

Competing Interests: All authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Comparison of symptom duration between PVT patients with and without portal cavernoma.
There was no significant difference in symptom duration between two groups.
Figure 2
Figure 2. Comparison of superior mesenteric vein (SMV) occlusion between patients with and without recent episode of symptoms.
SMV occlusion in patients with symptoms was significantly higher than those without symptom. *p<0.01.
Figure 3
Figure 3. Comparison of portal vein (PV) occlusion between patients with and without cavernoma.
PV occlusion in patients with cavernoma was significantly higher than those without cavernoma. *p<0.001.
Figure 4
Figure 4. Cross-sectional CT image of portal vein thrombosis and cavernoma: A) partial PVT (black arrow) without cavernoma; B) partial PVT (black arrow) with cavernoma (white arrow); C) complete PVT (black arrow) without carvernoma and D) complete PVT (black arrow) with cavernoma (white arrow).
Figure 5
Figure 5. Cirrhotic morphology in CT imaging.
Portal venous phase CT scan shows nodularity on the liver surface and heterogeneity of the liver parenchyma. A ratio of transverse caudate lobe width (black arrow) to right lobe width (white arrow) is greater than 0.65. Splenomegaly was present.
See this image and copyright information in PMC

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