What are the symptoms of Portal Vein Thrombosis (PVT) when it's incidentally found?

Symptoms of Portal Vein Thrombosis (PVT) When Incidentally Found

Portal vein thrombosis is often asymptomatic when discovered incidentally due to the formation of collateral veins, especially in chronic cases. 1

Acute PVT Symptoms

Acute PVT (symptoms present for 8 weeks or less) typically presents with:

• Abdominal pain (often mid-abdominal, colicky) 1
• Abdominal distention 1
• Nausea and vomiting 1
• Anorexia 1
• Diarrhea 1
• Fever (may indicate progression to bowel infarction) 1
• Hepatomegaly 1
• Ascites 1
• Rebound tenderness and guarding (suggests possible bowel infarction) 1
• Gastrointestinal bleeding 2

Chronic PVT Symptoms

Chronic PVT (symptoms present for more than 8 weeks) may present with:

• Often asymptomatic due to collateral vein formation 1, 3
• Abdominal pain (may be postprandial) 1
• Nausea and vomiting 1
• Anorexia 1
• Lower-extremity edema 1, 3
• Splenomegaly 1
• Weight loss 1
• Abdominal distension 1
• Complications of portal hypertension:
  • Esophageal, gastric, duodenal, or jejunal varices 1, 4
  • Variceal bleeding 1, 5
  • Ascites 5

Signs of Portal Hypertension

The presence of these findings indicates portal hypertension associated with chronic PVT:

• Splenomegaly 1
• Esophageal varices 1
• Pedal edema (particularly in chronic presentations) 3
• Cavernous transformation of the portal vein (cavernoma) on imaging 1

Clinical Pearls and Pitfalls

1. Incidental PVT is common: The signs and symptoms of PVT can be subtle or nonspecific and may be overshadowed by underlying illness 6

2. Risk factor assessment: When PVT is found incidentally, evaluate for:

   • Cirrhosis 1, 4
   • Abdominal malignancies (hepatocellular or pancreatic carcinoma) 1, 6
   • Myeloproliferative disorders 1, 5
   • JAK2 V617F mutation 1
   • Paroxysmal nocturnal hemoglobinuria 1
   • Recent abdominal surgery (especially splenectomy) 1
   • Pancreatitis 1
   • Exogenous estrogen use 1

3. Diagnostic confirmation: When PVT is suspected or incidentally found on ultrasound, confirm with:

   • CT angiography (preferred for mesenteric vein involvement) 3
   • MR venography (useful when biliary complications are suspected) 3

4. Chronic vs. acute differentiation: The presence of portal cavernoma (collateral formation around portal vein) on imaging indicates chronic thrombosis 1

5. Mortality implications: In patients with hepatocellular carcinoma, PVT is associated with significantly decreased survival 1