Portal Vein Thrombosis and Splenic Infarction in a COVID-19 Patient

Abstract

COVID-19 is a novel viral infection that primarily affects the lungs and runs the gamut from a mild, self-limiting, febrile illness to respiratory failure and death. It manifested as a global pandemic in 2020 and has since claimed millions of lives. Only a few months into this pandemic, it became evident that the viral infection leads to a hypercoagulable state. Anticoagulants became a standard and important part of therapy while d-dimer became a useful test to guide the choice of the anticoagulant (therapeutic vs prophylactic Lovenox). What remains unclear is how viral pneumonia can cause hypercoagulability, especially when it leads to thrombosis in unusual sites such as the portal vein. Another important question that remains unanswered is the duration of anticoagulation after discharge in the outpatient setting. Our case report addresses both these questions with an intriguing patient who presented with abdominal pain as the chief complaint in the absence of any respiratory symptoms whatsoever.

Keywords: covid-19; hyper coagulopathy; splenic infarcts; therapeutic anticoagulation; thrombosis.

Figure 1. Chest x-ray is negative for ground-glass opacities that are classically present in COVID-19 pneumonia.

Figure 2. CT abdomen reveals non-opacification of the right portal vein (green arrow). On the right, splenic infarct within the parenchyma is notable (red arrow).