Splenic & portal vein thrombosis

Case example

Blocked abdominal roads

An 8-year-old, male-castrated Mestizo presented for ongoing lethargy and acute onset of vomiting

CT findings

  • Image Set 1: Large, oval filling-defect extends within portal vein on post i.v. contrast administration images, nearly completely occupying its lumen
  • Image Set 2: Additional elongated filling-defects extend through multiple splenic veins causing multifocal complete luminal attenuation
  • Image 3: Diffuse splenic enlargement with innumerable rounded to amorphous homogenously contrast enhancing areas throughout parenchyma
  • Image 4: Abdominal lymph node enlargement with heterogenous contrast enhancement

Conclusions

  • Splenic & portal vein thrombosis with complete and near complete luminal stenosis, splenomegaly with parenchymal nodules and moderate abdominal lymph adenomegaly
  • Differential diagnosis: Round cell neoplasia — Lymphoma

Take Home

  • Other differential diagnoses with venous thromboses include disseminated intravascular coagulopathy, exogenous cortisol therapy/hyperadrenocorticism, pancreatitis, hepatic, immune-mediated disease, protein-losing enteropathy, other round cell neoplasms.
  • Multi-phase CT is imaging modality of choice for detecting thromboemboli as luminal filling-defects on post intravenous contrast administration images.
  • CT allows for thrombus localization, scrutinization of extension, number, to confirm or refute acquired shunting and for follow-up evaluation.

More information

  • »Portal Vein Thrombosis in 33 dogs: 1998-2011«
    — Respess et al.., VJ Vet Intern Med; 1012; 26:230-237
  • »Calvarial Hyperostosis syndrome in two bullmastiffs«
    — MConnell et al., Vet Radiol & Ultrasound 2006; 47(1): 72-77
  • »Diagnostic utility of computed tomographic angiography in dogs with portal vein thrombosis«
    — Sato et al., J Vet Med Sci 2020; 282(10): 1421-142

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