Portal Vein
Obstruction
Epidemiology and
Etiology:
- Acute obstruction:
- May
occur in setting of abdominal sepsis
- Trauma
- Cirrhosis
- HCC
growth into main portal vein
- Chronic:
- Thrombosis
is most frequent mechanism
- Usually
secondary to obstruction,
- Cirrhosis
- Tumour in the hepatic hilum or pancreas
- Early
PBC (small portal vein disease)
- Venous
inflammation,
- PSC
(hilar bile leak)
- Post-transplant
- Splanchnic sepsis
- Variceal scleropathy
- Trauma
- Blunt
abdominal injury
- Surgery
complication
- Or a
hypercoagulable state
- Inherited
clotting abnormalities
- Platelet
abnormalities
- Polycythemia vera
- Other
myeloproliferative diseases
- Thrombosis
of small portal veins:
- Inflammation
in the portal tracts from any chronic disease
Common sites:
Gross features:
- Chronic
portal vein obstruction:
- Portal
vein thrombosis usually
- May be
recanalized to any extent
- Cavernous
transformation maybe
- Thrombosis
with multiple recanalized channels
- Absent
or hypoplastic portal vein maybe
- Persistent
ductus venosus
- Multiple
local collaterals of portal vein to other veins
- Renal
vein
- Adrenal
vein
- Umbilical
via round ligament
- Aneurismal
dilatation of portal vein maybe
- Cirrhosis
commonly
- Varices
- Splenomegaly
- Ascites is usually absent
- Acute portal
vein obstruction:
- Thrombosis
of portal vein
- Thrombosis
of mesenteric veins
- Infarction
of the intestines
Histologic
features:
- Atrophy
of involved liver parenchyma
- Uniform
or mixed in a nodular regenerative hyperplasia pattern
Immunophenotype:
Marker:
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Sensitivity:
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Specificity:
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Molecular features:
Other features:
- Thrombocytopenia
- Hyperammonemia with portosystemic shunting
- clinical
features
- hepatic
encephalopathy with portosystemic shunting
References:
- Odze RD, ed. (2004)
Surgical Pathology of the GI Tract, Liver, Biliary
Tract, and Pancreas.