scholarly journals Portal vein thrombosis in COVID-19 infection

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Stefanie Sinz ◽  
Florian Glaser-Gallion ◽  
Thomas Steffen
Keyword(s):  
Abdominal Pain ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Nasopharyngeal Swab ◽  
Molecular Testing ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
Molecular Tests ◽  
Therapeutic Anticoagulation ◽  
Test Result

Abstract Background The COVID-19 pandemic has rapidly spread worldwide. As it is a novel disease, we have less experience in its possible appearances. Predominantly affecting the respiratory tract, about 20–43% patients also present with extrapulmonary manifestations such as coagulation disorders with thrombotic angiopathy. Case presentation In our institution, a patient presented to the emergency department with acute abdominal pain which was caused by portal vein thrombosis. As a COVID-19 nasopharyngeal antigen swab few days earlier was negative, we performed several tests to find out its etiology. After all tests were inconclusive and the patient suffered flu-like symptoms 2 weeks before, we repeated COVID-19 molecular testing and received a positive test result. The patient was treated symptomatically and received therapeutic anticoagulation. Conclusion A COVID-19 infection can also be present without typical pulmonary symptoms. In patients with severe abdominal pain and new diagnosed portal vein thrombosis, it is important to think of a COVID-19 infection. Also, the reliability of antigen nasopharyngeal swab should be considered critically, especially if performed wrongly. We recommended to perform molecular tests when in doubt. After the diagnosis of portal vein thrombosis, immediate anticoagulation is recommended to reduce the risk of further complications like intestinal infarction.

scholarly journals Acute portal vein thrombosis secondary to COVID-19: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Roham Borazjani ◽  
Seyed Reza Seraj ◽  
Mohammad Javad Fallahi ◽  
Zhila Rahmanian
Keyword(s):  
Abdominal Pain ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Acute Abdominal Pain ◽  
Anticoagulation Therapy ◽  
Pulmonary Complications ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
Extra Pulmonary ◽  
Secondary Causes

Abstract Background COVID-19 pneumonia exhibits several extra-pulmonary complications. Case presentation A 23-year old, asthmatic male with coronavirus pneumonia developed with generalized, acute abdominal pain. Further evaluations revealed a mild ascites and portal vein thrombosis although the patient received proper anticoagulation therapy. Routine lab data regarding the secondary causes of portal vein thrombosis were normal. Conclusion We speculated that the underlying cause of portal vein thrombosis in our case was coronaviruses. Therefore, clinicians should always consider thrombosis and other hypercoagulable diseases in patients with COVID-19.

3201 Acute Portal Vein Thrombosis Presenting With Atypical Abdominal Pain: A Rare Presentation

2019 ◽  
Vol 114 (1) ◽  
pp. S1710-S1710
Author(s):  
Tejinder Randhawa ◽  
Ishaan Vohra ◽  
Yazan Abu Omar ◽  
Ricky Patel ◽  
Estefania Flores
Keyword(s):  
Abdominal Pain ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Rare Presentation ◽  
Vein Thrombosis

Paroxysmal Nocturnal Hemoglobinuria With Budd-Chiari Syndrome Treated With Complement Inhibitor Eculizumab; A Case Report

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4800-4800
Author(s):  
Federica Valeri ◽  
Alessandra Borchiellini ◽  
Piercarla Schinco ◽  
Mario Boccadoro
Keyword(s):  
Abdominal Pain ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Haemolytic Anaemia ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Cerebral Veins ◽  
Budd Chiari Syndrome ◽  
Vein Thrombosis ◽  
Chiari Syndrome

Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired haemolytic anaemia caused by somatic mutation in the phosphatidylinositol glycan-complementation class A gene, resulting in absence of a key complement regulatory protein, CD59. Thrombosis occurs in up to 40% of PNH patients; it usually involves abdominal and cerebral veins and it is the leading cause of death disease related. Methods We describe the response to Eculizumab (Soliris, Alexion) in 28 years old male with PNH diagnosed as a consequence of Budd Chiari Syndrome, acute liver dysfunction, mild haemolytic anaemia and thrombocytopenia. Results The patient was admitted to the gastroenterology department with acute abdominal pain, fatigue, hemolytic anaemia, thrombocytopenia and transaminitis. Abdominal doppler ultrasonography (US) was immediately performed with detection of Budd Chiari Syndrome, portal vein thrombosis, initial portal hypertension and ascites. He was started on low dose low molecular weight heparin (platelets < 40x10^9/L), but despite anticoagulation progressive liver damage occurred, with poor pain control and worsening ascites. At the same time, we observed rapid exacerbation of thrombocytopenia and increasing in hemolysis tests with lactate dehydrogenase (LDH) reaching 1766 U/L, unresponsive to steroids administration. Bone marrow biopsy was negative but peripheral blood flow cytometry characterized a large PNH clone (85% total red blood cells). Furthermore, liver biopsy identified advanced stage of idiopathic cirrosis. Eculizumab therapy was then initiated at a dose of 600 mg weekly for 4 weeks and then 900 mg every 14 days. During the first month, transaminases progressively normalized and platelets settled permanently above 40x10^9/L, allowing therapeutic dose of anticoagulation. LDH dropped from basal value of >1000U/L to 600U/L and progressive reduction in abdominal pain was observed. Recanalization of portal vein thrombosis was found out at the US doppler after 6 weeks of anticoagulation, but recanalization of sovraepatic veins was not yet detectable. Conclusions Currently, after 17 Eculizumab administrations, platelets are 44 x 10^9/L, Hb 11.9 g/dl, AST 26 mg/dl, ALT 55 mg/dl, GGT 123 mg/dl, LDH 518 U/L. No further thrombotic episodes occurred, no ascites was detected as well as portal hypertension signs, performing ultrasonography monitoring. This case shows that Eculizumab can block intravascular haemolysis and platelet consumption and can improve hepatic failure, allowing full dose of anticoagulant as therapy for current thrombosis or as prophylaxis for future events. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Portal Venous Thrombosis in a Special Operations Paratrooper: A Case Report

2021 ◽  
Author(s):  
Rachel E Bridwell ◽  
Sean Clerkin ◽  
Nathaniel R Walker ◽  
Brit Long ◽  
Sarah Goss
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal System ◽  
Thrombotic Occlusion ◽  
Special Operations ◽  
Vein Thrombosis ◽  
Portal Venous Thrombosis ◽  
Abdominal Infections

ABSTRACT Portal vein thrombosis is the thrombotic occlusion of the extrahepatic portal system, which can propagate towards the vena caval system. Although rare, it occurs primarily in those with cirrhosis, intra-abdominal infections, malignancy, or hypercoagulable disorders. This report describes the first reported case of a soldier within special operations without identifiable risk factors who was found to have a completely occlusive portal vein thrombosis after approximately 10 days of insidious abdominal pain. This case emphasizes the importance of considering this rare but dangerous pathology among this highly screened and capable special operations population.

scholarly journals P-BN09 Management of isolated splenic vein thrombosis: Risks and benefits of Anticoagulation

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Amar M Eltweri ◽  
Mohammed Basamh ◽  
Ying Yang Ting ◽  
Mark Harris ◽  
Giuseppe Garcea ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Ct Scan ◽  
Portal Vein Thrombosis ◽  
Variceal Bleeding ◽  
Splenic Vein ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Anticoagulation Treatment ◽  
Therapeutic Anticoagulation

Abstract Background Isolated splenic vein thrombosis (iSVT) is a common complication of pancreatic disease. Whilst patients remain asymptomatic, there is a risk of sinistral portal hypertension and subsequent bleeding from gastric varices if recanalization does not occur. There is a wide variation of iSVT treatment, even within single centres. We report outcomes of iSVT from tertiary referral hepatobiliary and pancreatic (HPB) units including the impact of anticoagulation on recanalization rates and subsequent variceal bleeding risk.   Methods A retrospective cohort study including all patients diagnosed with iSVT on CT scan abdomen and pelvis between 2011 and 2019 from two institutions. Patients with both SVT and portal vein thrombosis at diagnosis, and isolated splenic vein thrombosis secondary to malignancy were excluded. The outcomes of anticoagulation, recanalization rates, risk of bleeding, and progression to portal vein thrombosis were examined. Results Ninety-eight patients with iSVT were included; of which thirty-nine patients received anticoagulation (40%). The most common cause of iSVT was acute pancreatitis n = 88 (90%). The recanalization rate in the anticoagulation group was 46% vs 15% in patients receiving no anticoagulation (p = 0.0008, OR = 4.7, 95% CI 1.775 to 11.72). Upper abdominal vascular collaterals (demonstrated on CT scan angiography) were significantly less among patients who received anticoagulation treatment (p = 0.03, OR = 0.4, 95% CI 0.1736 to 0.9288). The overall rate of upper GI variceal related bleeding was 3% (n = 3/98) and it was independent of anticoagulation treatment. Two of the patients received therapeutic anticoagulation. Conclusions The current data support that therapeutic anticoagulation is associated with a statistically significant increase in recanalization rates of the splenic vein; with a subsequent reduction in radiological left-sided portal hypertension. However, all patients had a very low risk of variceal bleeding regardless of anticoagulation. The findings from this retrospective study should merit further investigation in large-scale randomized clinical trials.

Cytomegalovirus (CMV)-associated portal vein thrombosis in a healthy, immunocompetent man

2020 ◽  
Vol 13 (12) ◽  
pp. e238645
Author(s):  
Caroline Burkey ◽  
Catherine Teng ◽  
Khalil Ian Hussein ◽  
James Sabetta
Keyword(s):  
Abdominal Pain ◽  
Literature Review ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Abdominal Ct ◽  
Vein Thrombosis ◽  
Abdominal Ct Scan ◽  
Specific Symptoms ◽  
Acute Cytomegalovirus

We present a previously healthy man in his 30s who presented with typical viral prodrome symptoms and worsening abdominal pain. He was found to have portal vein thrombosis, with extensive hypercoagulability workup performed. It was determined that the aetiology of thrombus was secondary to acute cytomegalovirus infection. The patient was started on anticoagulation therapy, with later clot resolution demonstrated on abdominal Doppler ultrasound and abdominal CT scan. Given the atypical presentation of this common virus, we performed a literature review of cytomegalovirus-associated portal vein thrombosis in healthy individuals; we found that most patients present with non-specific symptoms of fever and abdominal pain in the setting of a viral prodrome. This case and literature review suggest physicians must consider cytomegalovirus-associated portal vein thrombosis as a potential diagnosis when patients present with abdominal pain and viral symptoms. The literature highlights the need for a consensus on anticoagulation and antiviral therapy.

scholarly journals Management of incidental splanchnic vein thrombosis in cancer patients

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 318-320 ◽  
Author(s):  
Lisa Baumann Kreuziger ◽  
Walter Ageno ◽  
Agnes Lee
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Portal Vein ◽  
Ct Scan ◽  
Cancer Patients ◽  
Portal Vein Thrombosis ◽  
Metastatic Pancreatic Cancer ◽  
Splanchnic Vein Thrombosis ◽  
Vein Thrombosis

Abstract A 75-year-old male with metastatic pancreatic cancer is undergoing chemotherapy with gemcitabine. A portal vein thrombosis was incidentally found on surveillance CT scan. He does not report any new abdominal pain or ascites. Should anticoagulation be used to treat asymptomatic portal vein thrombosis?

scholarly journals Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Murad Baba ◽  
Jordan Fakhoury ◽  
Amer Syed
Keyword(s):  
Morbid Obesity ◽  
Abdominal Pain ◽  
Sleeve Gastrectomy ◽  
Portal Vein ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Gene Mutation ◽  
Portal Vein Thrombosis ◽  
Vein Thrombosis ◽  
Prothrombin Gene Mutation ◽  
Prothrombin Gene

Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG). It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT) after LSG.Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation.Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

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