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00133419

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RADIOLOGY: VASCULAR: Case# 32845: PVT, SRS, LARGE VARICES. This is a 53 year old female with a recent history of a right hip abscess. Patient presents for work-up of fever of unknown origin. There is marked splenomegaly, large amount of varices, cirrhosis, marked bowel wall edema in both the small bowel and in the colon, pericardial effusion, hiatal hernia, and free fluid within the peritoneal cavity most predominantly in the pelvis. No focal lesions are seen in the liver, spleen, kidneys, or pancreas. Portal vein thrombosis may be caused by hypercoagulable states, malignancy, infections, and hepatic venous obstruction. It is best visualized using incremental dynamic imaging technique. it is seen as enlarged vessels with enlarged or enhanced walls with a small amount of contrast passing around thrombus. The vessel usually has a low central density, and there are regional changes of contrast enhancement in the pattern of the liver. Serial CT may show changes in location or extent of the thrombus, recanalization of part of the vessel, or retraction of the thrombus with collateral vein enlargement. A PVT may cause periportal collaterals to dilate forming cavernous transformation. There may be a decrease in parenchymal enhancement to regions supplied by occluded branches.

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