Age: 77
Sex: Female
Indication: Upper abdominal pain, fever
Save ("V")
Case #83
Findings
- Lower chest
- Pulmonary nodule in the medial aspect of the left lower lobe measuring 2 x 1.5 cm
- No pleural effusions
- Small hiatal hernia
- Abdomen/Pelvis
- Occlusive thrombosis of the left portal venous system with wall thickening and hyperenhancement of the thrombosed veins
- Thrombus also involves right portal venous branches to a lesser extent
- The main portal vein, splenic vein, and SMV remain patent
- Heterogeneous enhancement of the hepatic parenchyma
- Mural thickening of the gallbladder and extrahepatic bile ducts, which are nondilated
- Punctate calcified gallstone layering in the gallbladder fundus
- Mildly prominent lymph node in the gastrohepatic ligament measuring 8 mm in short axis
- Colonic diverticulosis and small periampullary duodenal diverticulum without evidence for acute diverticulitis
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- MSK
- No acute findings
- Peripherally calcified bilateral breast implants with areas of intracapsular rupture bilaterally
Diagnosis
- Pylephlebitis
Sample Report
Occlusive thrombosis of the left portal venous tree with associated venous wall thickening and enhancement, suspicious for thrombophlebitis (pylephlebitis). Additional areas of thrombus involving right portal venous branches. The main portal vein, splenic vein, and SMV remain patent.
Gallbladder and extrahepatic biliary duct wall thickening, which may relate to cholecystitis and cholangitis. No evidence for biliary obstruction.
Heterogeneous enhancement of the hepatic parenchyma, which may relate to altered perfusion in in the setting of portal venous thrombosis, though hepatitis could have a similar appearance. No evidence for hepatic abscess.
Left lower lobe pulmonary nodule measuring 2 cm, which is concerning for primary or metastatic malignancy. Recommend chest CT for further assessment.
View shortcuts
Zoom/Pan
Full screen
Window/Level
Expand/collapse
Scroll
Save the case
Close case/tab
Toggle presets
Previous series (if multiple)
Next series (if multiple)
