Splenic artery aneurysms and extrahepatic portal hypertension during pregnancy

Clinical case demonstrates successful treatment of a pregnant woman, who had multiple giant splenic artery aneurysms with a high risk of spontaneous rupture. Pregnancy proceeded along with hereditary thrombophilia, thrombosis and cavernous transformation of the vena cava, extrahepatic portal hypertension, esophageal and gastric varices II–III. The surgical and obstetric tactics, surgical intervention, appropriate salvage and multidisciplinary pregnancy follow-up ensured a successful Cesarean delivery at 38 weeks, saving the life of the child and mother.

Prior History of Thrombosis, Meld, BMI and the Presence of Esophageal Varices Predict Thrombus Progression in Patients with Untreated Splanchnic Vein Thrombosis

Background: Splanchnic vein thrombosis (SVT) occurs in a heterogenous group of patients secondary to a variety of risk factors including acute and chronic liver disease, malignancy, and myeloproliferative neoplasms. There is equipoise on the utility of anticoagulation in many patients with SVT given the perceived risks of bleeding and unclear benefits. We sought to determine which clinical factors predict new or progressive thrombosis in a cohort of patients with SVT. Methods: We undertook a retrospective cohort study of patients over 18 years of age identified to have an SVT at the Oregon Health & Science University from 01/01/2015 - 12/31/2020, including only patients who were not initially treated with anticoagulation at the time of their initial VTE diagnosis. Relevant clinical variables were selected apriori. The primary study endpoint was imaging-confirmed progression of SVT, development of cavernous transformation, intestinal ischemia, or new venous or arterial thrombosis. Chart demographics, patient history, and relevant lab values at the time of initial SVT were extracted for the analysis. Descriptive analysis, univariate logistic regression, and multivariable logistic regression were performed in STATA version 12.1 and R (R core team 2019). Results: Seventy-eight patients were included in the analysis (mean age 60 years old, 74% male). The most common SVT in the cohort was isolated portal vein thrombosis (N=60) followed by thrombosis of multiple splanchnic veins (N=14). The most prevalent causes of liver disease in the cohort were viral hepatitis (N=33) alcoholic cirrhosis (N=20) and non-alcoholic steatohepatitis (N=12). 66% of patients had known varices at diagnosis. 33% had thrombosis directly associated with a tumor. The mean platelet count and INR were 105 x 109/L and 1.55 respectively. Twenty-two patients (28%) developed the primary endpoint of thrombus progression. Univariate logistic regression found that prior history of thrombosis (OR 6, P= 0.04) and the presence of varices at diagnosis (OR 4.4, P= 0.02) were associated with progression. We then created a multivariable logistic regression model and observed that total bilirubin (ORadj = 0.34, p = 0.03), MELD score (ORadj = 1.33, p = 0.04), the presence of varices (ORadj = 11.7, 0.03), and BMI (ORadj = 1.14, p = 0.047) were significant predictors of our composite outcome while controlling for age, glomerular filtration rate, INR, and prior history of VTE. Discussion: In our heterogenous cohort of patients with SVT not treated with anticoagulation, one in four patients developed the composite endpoint of SVT progression, development of cavernous transformation, intestinal ischemia, or new venous or arterial thrombosis. Several common clinical variables appear to be predictive for thrombus progression, suggesting that predictive models may be feasible to determine which patients with SVT are likely to benefit from anticoagulation. Disclosures Shatzel: Aronora Inc,: Consultancy.

A voluminous portal cavernoma of the hepatic pedicle with severe portal hypertension

Portal cavernoma is the cavernous transformation of the portal vein. It is the consequence of chronic portal vein thrombosis and occurs when collateral branches develop to bypass the portal occlusion. The clinical presentation includes hematemesis due to variceal bleeding, ascites or anemia, and splenomegaly. Herein we present images of a 37-year-old male patient received in our department for abdominal ultrasound, following 2 episodes of hematemesis. This case illustrates the ultrasound aspect of a voluminous portal cavernoma with portal hypertension signs.

Detection of Cavernous transformation of the portal vein in a 22-year-old male with upper gastrointestinal bleeding and anemia by Abdominal Duplex Ultrasonography. A Case Report.

Cavernous transformation of the portal vein (CTPV) is a rare condition characterized by the formation of multiple tortuous tiny blood vessels within and around a portal vein which has been occluded by thrombus. Early diagnosis of CTPV is relevant for timely intervention which could save the liver from non-reversible damage