Embolism / Thrombosis, Complications, Diagnostic procedure, CT-Angiography, CT, Gastrointestinal tract, Veins / Vena cava, Abdomen, Ischaemia / Infarction, Obstruction / Occlusion
M. Valle Franco1, L. Martínez González1, A. M. Fernández Martínez1, C. Torrez Villarroel2, M. Berlioz Ortiz3, I. M. LÓPEZ GARCÍA3, F. J. SOMALO ALFARO2, M. Pérez Rodríguez1, A. Pérez Termenón1; 1León/ES, 2León, Castilla y León /ES, 3leon/ES
Findings and procedure details
Below we present the diagnosed cases of MVT in our center in the last five years and describe the findings detected by contrast-enhanced MDCT of the abdomen:
Fig. 3: Fig. 3 and Fig. 4: A 50-year-old man with acute diverticulitis complicated with perforation (red arrow) and thrombosis of the portomesenteric confluence (yellow arrow). Presence of free fluid (blue arrow), sigma thickening (green arrow) and pneumoperitoneum bubbles (red arrow).
Fig. 4: Fig. 3 and Fig. 4: A 50-year-old man with acute diverticulitis complicated with perforation (red arrow) and thrombosis of the portomesenteric confluence (yellow arrow). Presence of free fluid (blue arrow), sigma thickening (green arrow) and pneumoperitoneum bubbles (red arrow).
Fig. 5: Same patient as in figures 3 and 4, with gas in the inferior mesenteric vein (yellow arrows), enhancement and slight thickening of its wall and rarefaction of the adjacent fat.
Fig. 6: Acute thrombosis of the distal branches of the superior mesenteric vein (yellow circle) in a patient with small cell lung carcinoma. It's accompanied by mesenteric edema (free fluid and fat stranding).
Fig. 7: Same case as in figure 6, with proximal extension of the thrombus to the superior mesenteric vein (yellow arrow). See the central venous hypodensity as a filling defect, with vein parietal enhancement and increase in vascular caliber with respect to subsequent control (figure 9).
Fig. 8: Mesenteric venous congestion and edema (free fluid and increased mesenteric fat density) secondary to the MVT of figures 6 and 7.
Fig. 9: Favorable evolution of the thrombosis of the superior mesenteric vein of figure 7, with recovery of the vascular caliber and decrease of the repletion defect (blue arrow).
Fig. 10: Male with abdominal pain, colic-type exacerbations and weight loss of 1 month of evolution and with bloody stool in the last 2 days. Massive MVT, from the portal vein (thick yellow arrow) and the superior mesenteric vein (thin yellow arrows) to its terminal branches (yellow circle). There is a thickening of the ileum (long red arrows) with the target sign (short red arrows) in a long segment of ileal loops, free fluid (blue arrows) and venous engorgement in the root of the mesentery.
Fig. 11: Cirrhotic patient with a liver with lobulated contour and typical morphology of chronic liver disease (blue circle), splenomegaly (blue arrow) and lower esophageal, splenic and gastric varices (yellow circles), signs that translate portal hypertension. We can see a peripheral chronic thrombosis of the superior mesenteric vein on its confluence in the portal vein (yellow arrows).
Fig. 12: A patient with colon cancer operated suffers a thrombosis of several distal branches of the superior mesenteric vein (yellow circle) with edema of the adjacent fat and venous engorgement.
Fig. 13: Resolution of the thrombosis of figure 12 with disappearance of the adjacent fat edema and venous engorgement after anticoagulant treatment.