Superior mesenteric and portal vein thrombosis

Discussion:

Acute venous mesenteric thrombosis (VMT) is not the most frequent vascular pathology of the colon and/or small intestines. Arterial compromise is far more common. Signs and symptoms are vague and nonspecific, but a soon diagnosis is key to avoid complications and even death. Bowel ischemia and infarction is common in arterial occlusion but rare in venous occlusion. It represents 5-15% of the total mesenteric ischemic events.

CT signs you should intentionally search for are: 

  • venous filling defect
  • mesenteric vein enlargement
  • collateral circulation
  • circumferential bowel wall thickening
  • pneumatosis intestinali
  • portomesenteric venous gas
  • mesenteric fat edema

Different types of intra abdominal inflammation are a common cause of VMT (pancreatitis, diverticulitis, appendicitis, etc), as well as portal hypertension, hypercoagulable states, cancer (pancreas, liver) and myeloproliferative neoplasms. Systematic search for the underlying cause is mandatory. 

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