Splenic Vein Thrombosis: A Case Series of Consequential Chronic Pancreatitis and Sequential Myeloproliferative Disorder

Abstract

We present a case series of two patients with splenic vein thrombosis (SVT), a relatively uncommon condition supposed to occur in the context of pancreatitis or pancreatic malignancies. Splenic vein thrombosis may also be seen in cases of chronic pancreatitis, as in one of our patients. At times, splenic vein thrombosis may present with an incidental, isolated finding of gastric varices on computed tomography pulmonary angiogram (CTPA) while investigating for pulmonary embolus; such a result should prompt further investigation to rule out associated splenic vein thrombosis in a sequence. We attempt to highlight the importance of performing a blood count and hematocrit, supplementary to a liver screen, in another patient where the cause was not related to liver disease, but to myeloproliferative disorder, which resulted in a hyper-thrombotic state and splenic vein thrombosis as a consequence.

Keywords: chronic pancreatitis; direct-acting oral anticoagulants; myeloproliferative disorder; polycythemia rubra vera; splenic vein thrombosis.

Figure 1. Computed tomography pulmonary angiogram (CTPA) with gastric varices (blue arrows).

Figure 2. Computed tomography (cross-sectional view) with splenic vein thrombosis (yellow arrow).

Figure 3. Upper orogastroduodenoscopy. A) Prominent gastric fold along the proximal stomach (blue arrows). B) Stomach in retroflexion with a prominent gastric fold along the proximal stomach (yellow arrows).

Figure 4. Computed tomography (sagittal view) with the irregular contour of the liver (pink arrows), partially occluded splenic vein thrombus (blue arrow), and splenomegaly (yellow arrow).

Figure 5. Orogastroduodenoscopy (OGD) demonstrating no evidence of varices, no portal gastropathy, and mild gastritis (yellow arrows).