Table 2.
Differential diagnosis for PVT associated findings with risk and frequency of underlying causes.
| Cause | Labs | Clinical findings | Imaging | PVT frequency | PVT risk |
|---|---|---|---|---|---|
| Liver cirrhosis | CBC, liver chemistry [3] | Ascites, jaundice, hepatic encephalopathy, gastrointestinal bleeding, portal hypertension, abdominal pain [2] | Irregular liver outline, portal vein dilation [2] | Incidence: 11.2%-16.6% [2], [3] |
Odds ratio: 17.1 in cirrhosis with primary hepatic cancer, 5.2 in cirrhosis without primary hepatic cancer[3] |
| Liver carcinoma | Serum AFP levels [9] | Advanced stage, major vessel involvement, low serum albumin, high serum AFP levels [3] | Filling defect with rim enhancement of vessel wall, disruption of vessel wall, expansive effect due to tumor mass [2] | Incidence: 20%-44% [3], 35% in combination with cirrhosis [2] |
|
| Liver transplant | - | Decreased caliber of portal vein, donor/recipient portal vein diameter mismatch [2] | - | Incidence: 13.8% no portosystemic shunt, 38.9% prior portosystemic shunt [3] | - |
| Pancreatitis | Serum amylase/ lipase [15] | Premature activation of digestive enzymes and inflammation, acute severe epigastric pain radiating to the back [15] | Acute pancreatitis: Diffuse enlargement of pancreas, heterogeneous enhancement, peripancreatic stranding [15] | Incidence: 23% in acute pancreatitis, 57% in pancreatic necrosis [2] |
- |
| Hypercoagulable states (factor V leiden, protein C deficiency, protein S deficiency, antithrombin III deficiency, prothrombin mutation, antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria) |
Factor V mutation, protein C & S levels, ATIII, G20210A, cardiolipin, lupus anticoagulant, anti-beta2 glycoprotein antibodies, CD55/CD59 [2] |
Acute PVT: Abdominal pain, fever, ascites, splenomegaly [2] Chronic PVT: Recurrent upper abdominal pain, portal hypertension, varices, splenomegaly, anemia, thrombocytopenia [2] | Acute PVT: hypoechogenic/ hypodense/ hypointense thrombus, absence of porto-systemic collaterals [2] Chronic PVT: absent (fibrotic) portal vein with cavernoma, portal hypertension, wall/thrombus calcifications hyperdensities on CT [2] |
- | Relative risk: 10-20 in Protein C, Protein S, and Antithrombin III deficiency; 8 in Antiphospholipid syndrome [3] |
| Myeloproliferative disorders (PCV, ET) | JAK2 V617F [2], [3], [7] | 30%-40% [2], [3] | Odds ratio: 3.0 [10] |