generally non-specific symptoms (nausea, vomiting, anorexia, diarrhoea or constipation, and fever) although abdominal pain occurs in over half and less commonly GIT bleeding and/or ascites may occur
portal vein thrombosis (PVT)
acute presentation:
abdominal pain
chronic:
portal hypertension features such as hypersplenism, ascites, oesophageal varices, and the presence of portal cavernoma or other porto-systemic collateral veins on imaging
mesenteric vein thrombosis (MVT)
acute presentation:
sudden onset of abdominal pain and particularly if it extends into the superior mesenteric vein, may be complicated by intestinal infarction in one third of patients which may be fatal
subacute presentation:
abdominal pain lasting for several days without intestinal infarction
least common manifestation of SVT, with reported incidence rates of around 1–2 cases per million inhabitants per year (5-7 per million in the Eastern countries)
includes any obstruction of the hepatic venous outflow located between the small hepatic venules and the confluence of the IVC into the right atrium
Diagnosis
D-Dimer is generally elevated but has limited utility if there are other conditions present which may cause this such as cirrhosis, post-surgery, neoplasia or infections
Doppler USS is generally first line for suspected portal V thrombosis as has high sens and spec.
CT abdopelvis with contrast is the standard 1st line investigation for other types and for PVT when USS is not available
Treatment
if incidental and asymptomatic, current recommendation is no Rx unless acute extensive SVT or ongoing chemotherapy in cancer patients