Korean J Gastroenterol.  2016 Sep;68(3):156-160. 10.4166/kjg.2016.68.3.156.

Hepatic Infarction Caused by Portal Vein Thrombophlebitis Misdiagnosed as Infiltrative Hepatic Malignancy with Neoplastic Thrombus

• Shim M
• Yang TY
• Cho NG
• Woo A
• Kim E
• Park K
• Lee JH
• Lee YB
• Hwang SG
• Rim KS
• Park H

• KMID: 2358719
• DOI: http://doi.org/10.4166/kjg.2016.68.3.156

Abstract

Portal vein thrombosis (PVT) is a form of venous thrombosis that usually presents in chronic form without any sequalae in patients with hepatocellular carcinoma (HCC) or liver cirrhosis. Accurate differential diagnosis of bland PVT from neoplastic PVT is an important step for planning treatment options, but the acute form can be challenging. Here we present a case of acute hepatic infarction caused by acute bland PVT combined with pylephlebitis, which was misdiagnosed as infiltrative hepatic malignancy with neoplastic PVT owing to the perplexing imaging results and elevated tumor markers.

Keyword

Chronic hepatitis B; Tenofovir; Portal vein; Thrombophlebitis

MeSH Terms

Biomarkers, Tumor
Carcinoma, Hepatocellular
Diagnosis, Differential
Hepatitis B, Chronic
Humans
Infarction*
Liver Cirrhosis
Portal Vein*
Tenofovir
Thrombophlebitis*
Thrombosis*
Venous Thrombosis
Biomarkers, Tumor
Tenofovir

Figure

• 

  Fig. 1. Portal vein (PV) thrombosis on imaging studies. Suspiciously infiltrative and hypovascular hepatocellular carcinoma on S8 of markedly shrunken liver parenchyma with enhanced thrombosis (arrows) at right PV and main PV on CT scans. (A) Liver MRI revealed portal vein thrombosis on contrast enhanced fat suppression T1 portal phase (B), enhancement on early arterial phase of dynamic enhanced study (C), and on hepatobiliary phase (D).

• 

  Fig. 2. Acute hepatic infarction on liver MRI. Liver MRI at first visit showed ill-defined and slightly T2 high signal intensity lesion (arrows) on S8 of liver (A) and sustained high signal intensity on diffusion weighted imaging. (B) The lesion was not demarcated well on enhanced early arterial phase of dynamic study (C) or on hepatobiliary phase because of markedly decreased liver function (D).

• 

  Fig. 3. Liver tumor CT after 12 months showed a remaining wedge-shaped non-enhanced low attenuated lesion (arrow) on S8 of liver (A) and chronic partial thrombi (benign thrombi) (arrow) at anterior branch of right portal vein (PV) and main PV with arterioportal shunts (B).

• 

  Fig. 4. Serial changes of serum CA 19–9 and AFP levels.

Reference

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