Differential Diagnosis for Near Complete Occlusion of Main Portal Vein at Confluence with SMV and Splenic Vein Extrinsic Compression
- Single Most Likely Diagnosis
- Pancreatic cancer: This is the most likely diagnosis due to the location of the occlusion and compression, which is consistent with a tumor in the pancreatic head compressing the portal vein, SMV, and splenic vein.
- Other Likely Diagnoses
- Lymphoma: Lymphoma can cause extrinsic compression of the portal vein, SMV, and splenic vein due to lymphadenopathy in the region.
- Metastatic disease: Metastases to the lymph nodes or other structures in the region can also cause compression of these veins.
- Pancreatitis: Chronic pancreatitis can cause fibrosis and scarring that can lead to compression of the portal vein, SMV, and splenic vein.
- Do Not Miss Diagnoses
- Portal vein thrombosis: This is a potentially life-threatening condition that requires prompt anticoagulation. It can be caused by a variety of factors, including malignancy, infection, or hypercoagulable states.
- Splenic vein thrombosis: Thrombosis of the splenic vein can lead to sinistral portal hypertension and bleeding from varices.
- Rare Diagnoses
- Retroperitoneal fibrosis: This is a rare condition characterized by fibrosis and inflammation in the retroperitoneum, which can cause compression of the portal vein, SMV, and splenic vein.
- Sarcoidosis: Sarcoidosis is a systemic granulomatous disease that can cause lymphadenopathy and fibrosis, leading to compression of these veins.
- Castleman disease: This is a rare lymphoproliferative disorder that can cause lymphadenopathy and compression of the portal vein, SMV, and splenic vein.