Download

Download Full Text (1.2 MB)

Description

Portal vein thrombosis (PVT) and superior mesenteric vein (SMV) thrombosis are uncommon but potentially life-threatening venous obstructions of the GI tract associated with cirrhosis,

A 56-year-old man without significant medical history presented with several months of intermittent abdominal pain. Upon further evaluation, CT imaging revealed extensive SMV thrombosis extending to the portal vein without evidence of bowel ischemia. Initial treatment included anticoagulation, however over subsequent weeks despite appropriate treatment and compliance with anticoagulation, the patient had worsening abdominal pain. Additional imaging at that time demonstrated propagation of thrombosis involving the right and main portal, splenic, and the superior and inferior mesenteric veins. Further work-up with hematology and oncology services during this time revealed no identifiable malignancy or hypercoagulable disorders. Given ongoing progression despite anticoagulation, interventional radiology services were consulted for consideration of thrombectomy.

This case illustrates the challenges of managing refractory venous thrombosis and as well as the limitations of repeated endovascular intervention in the absence of a clearly defined underlying etiology. Progressive thrombosis despite anticoagulation and technically successful IR therapy should prompt reassessment for occult malignancy as these may be early manifestations of aggressive malignancy.

Publication Date

5-8-2026

Disciplines

Radiology

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2109

Discovery of a Sarcomatoid Malignancy in the Case of a Superior Mesenteric Vein and Portal Vein Thrombosis

Share

COinS