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Int J Angiol 2016; 25(05): e97-e99
DOI: 10.1055/s-0034-1544125
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Progression of Thrombus in Portal Vein, Superior Mesenteric Vein, and Splenic Vein Even on Anticoagulation in a Patient with Ascending Colonic Malignancy with Liver Metastasis: Portal Vein Thrombosis versus Portal Vein Tumor Thrombosis

Ashish Sule
1   Department of General and Vascular Medicine, Tan Tock Seng Hospital, Singapore
,
Annamarie Borja
1   Department of General and Vascular Medicine, Tan Tock Seng Hospital, Singapore
,
Tay Jam Chin
1   Department of General and Vascular Medicine, Tan Tock Seng Hospital, Singapore
› Author Affiliations
Further Information

Publication History

Publication Date:
01 June 2015 (online)

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Abstract

Portal vein thrombosis (PVT) in a setting of liver metastasis is not easy to treat as it may be portal vein tumor thrombus (PVTT). A 77-year-old male patient was diagnosed as ascending colon carcinoma, underwent right hemicolectomy in 1991 with a recurrence in July 2009. In August 2009, he underwent computed tomography (CT) scan of the abdomen which showed evidence of superior mesenteric vein thrombosis with no liver metastasis. He was started with anticoagulation and decision was to treat long term. He was admitted with mesenteric artery ischemic symptoms in February 2012 on anticoagulation. CT scan abdomen and pelvis in February 2012 showed tumor thrombus involving the superior mesenteric vein, portal vein, and splenic vein with hepatic metastasis. His tumor marker chorioembryonic antigen was 34 µg/L. He was continued on anticoagulation. A repeat CT scan abdomen after 2 years (in January 2014) showed, increase in size of hepatic metastasis, extensive thrombus involving the superior mesenteric vein, portal vein, and splenic vein with collaterals. Mesentery was congested due to extensive superior mesenteric vein thrombus. He finally succumbed in June 2014. It is very important to differentiate PVT from PVTT as the prognosis is different. PVTT progresses despite of long-term anticoagulation with poor prognosis.

Keywords

anticoagulation - colon - ischemia - malignancy - portal vein - thrombosis - tumour thrombosis
 

  • References

  • 1 Squizzato A, Ageno W, Cattaneo A, Brumana N. A case report and literature review of portal vein thrombosis associated with cytomegalovirus infection in immunocompetent patients. Clin Infect Dis 2007; 44 (2) e13-e16
    CrossrefPubMedGoogle Scholar
  • 2 DeLeve LD, Valla DC, Garcia-Tsao G ; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (5) 1729-1764
    CrossrefPubMedGoogle Scholar
  • 3 Sameer P, Riddhi S, Prashant K. Portal vein thrombosis. Am J Med 2010; 123 (2) 111-119
    CrossrefPubMedGoogle Scholar
  • 4 Chawla Y, Duseja A, Dhiman RK. Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 2009; 30 (9) 881-894
    CrossrefPubMedGoogle Scholar
  • 5 Dörffel T, Wruck T, Rückert RI, Romaniuk P, Dörffel Q, Wermke W. Vascular complications in acute pancreatitis assessed by color duplex ultrasonography. Pancreas 2000; 21 (2) 126-133
    CrossrefPubMedGoogle Scholar
  • 6 Yamamoto N, Sugano N, Morinaga S , et al. Massive portal vein tumor thrombus from colorectal cancer without any metastatic nodules in the liver parenchyma. Rare Tumors 2011; 3 (4) e47
    CrossrefPubMedGoogle Scholar
  • 7 Cedrone A, Rapaccini GL, Pompili M , et al. Portal vein thrombosis complicating hepatocellular carcinoma. Value of ultrasound-guided fine-needle biopsy of the thrombus in the therapeutic management. Liver 1996; 16 (2) 94-98
    PubMedGoogle Scholar