Portal vein thrombosis.

BACKGROUND: Most physicians in China may neglect portal vein thrombosis (PVT) in clinical practice. In fact, portal vein thrombosis is an important cause of non-cirrhotic portal hypertension. As the diversity of its clinical manifestations, misdiagnosis is common if we donot bear PVT in mind during differential diagnosis. Therefore, we systematically reviewed PVT in terms of etiology, pathophysiology, pathology, clinical manifestations, and management.

DATA SOURCES: An English language literature search (from 1980 to 2004) was performed using Medline and Medscape, and articles closely related to PVT were selected.

RESULTS: PVT is the second cause of portal hypertension after liver cirrhosis in western countries. Liver cirrhosis and hepatocellular carcinoma, intra-abdominal infection, thrombophilic disorders including myeloproliferative diseases are strongly associated with the development of PVT. Liver transplantation is an emerging etiological factor of PVT with the development and wide use of this technique. Gastrointestinal bleeding resulted from esophageal varices, abdominal pain, splenomegaly and hypersplenism and ascites are common manifestations of PVT. However there are differences in etiological and clinical presentations between children and adults. Diagnosis of PVT depends on imaging studies including Doppler ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and portography. Endoscopic therapy is recommended for variceal bleeding in PVT. Anticoagulant treatment for acute PVT is widely accepted in western countries.

CONCLUSIONS: PVT may be unrecognized as the clinical manifestations are unspecific. Misdiagnosis and delayed treatment can lead to poor prognosis. Systematical collection of epidemiological and clinical data about PVT is necessary in China.