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RADIOLOGY: VASCULAR: Case# 44: PORTAL VEIN THROMBOSIS WITH H/O GRANULOSA CELL CA. 40 y.o. female with intractable nausea and vomiting and fever for 3weeks. S/P Post TAH/BSO for granulosa cell tumor. Low attenuation thrombus extends from the portal vein into the superior mesenteric vein. There is strandy soft tissue attenuation of the adjacent fat. The liver has sharply demarcated heterogeneous enhacement with decreased attenuation in the posterior segment of the right lobe. A few serpinginous vessels in the area of the porta hepatis represent cavernous transformation of the portal vein. Causes of portal vein thrombosis include cirrhosis, inflamation (especially pancreatitis), myeloproliferative disorders, hypercoagulable states, and trauma. CT scans can show an iso- or hypodense filling defect within the portal vein; however, recent thrombus can be hyperdense. On dynamic scanning, there is increased attenuation of the hepatic segments supplied by the occluded portal branch due to compensatory augmented hepatic arterial flow. As in this case, cavernous transformation of the portal vein can be seen.

Peter Anderson
radiology, Vascular