Pylephlebitis / septic thrombophlebitis

Discussion:

This patient was admitted septic with raised inflammatory markers and mildly derranged liver function tests.

The CT study revealed there to be thrombus in the portal vein consistent with portal vein thrombus, in conjunction with ill-defined peri-portal vein swelling throughout the liver which is suggestive of inflammation.

The remainder of the abdominal viscera are normal. In view of the portal vein thrombus, raised inflammatory markers, sepsis and CT signs of peri-portal vein inflammation, a diagnosis of pylephlebitis was made.

MRCP and ERCP were both normal, in particular the CBD was of normal caliber.

Pylephlebitis of the portal vein is an acute ascending infection. It is often secondary to abdominal infection, such as appendicitis or diverticulitis.

The imaging findings are that of intra-hepatic peri-portal vein ill-defined low attenuation, as seen in this case, illustrating inflammation, in conjunction with portal vein thrombus.

No cause for the pylephlebitis was identified in this patient.

 

Presented with Dr. Ben Warner MD BSc MRCP, Clinical Fellow in Gastroenterology, Guy's and St Thomas' NHS Foundation Trust. 

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