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Emerg Radiol (2008) 15:433436 DOI 10.1007/s10140-007-0693-y
CASE REPORT
Pancreatitis-associated splenic vein thrombosis with intrasplenic venous thrombosis: a case report
Stephanie A. Schwartz & Alana Y. Stubbs &
Mihra S. Taljanovic & Stephen H. Smyth
Received: 2 November 2007 /Accepted: 29 November 2007 / Published online: 10 January 2008 # Am Soc Emergency Radiol 2007
Abstract Splenic vein thrombosis most often results from pancreatic disease and can result in gastrointestinal bleeding due to gastric varices. The diagnosis is becoming more frequent with the increasing utilization of imaging. This case report will review the imaging findings of splenic vein thrombosis with an illustration of the involvement of intrasplenic segmental venous branches.
Keywords Splenic vein . Thrombosis . Pancreatitis
Introduction
Splenic vein thrombosis can have a variety of causes, with pancreatic disease being the most common. Thrombosis of the splenic vein has been reported in 7 to 20% of patients with pancreatitis [1], with resultant risk of possible gastric variceal hemorrhage or hypersplenism [1, 2]. Involvement of intrasplenic venous branches is uncommon, with only three cases reported in the English language literature [3].
Case report
A 23-year-old male presented to the emergency department with left-upper-quadrant abdominal pain, nausea, and vomiting. Social history was significant for consumption of 8 oz of liquor per day. Laboratory evaluation was significant for elevated amylase (397 IU/L; normal 22122 IU/L) and lipase (264 U/L; normal 760 U/L) levels, as well as evidence of alcoholic liver disease with total bilirubin of 1.7 mg/dL (normal 0.31.2 mg/dL), aspartate transaminase (AST) of 148 IU/L (normal 1045 IU/L), and alanine transaminase (ALT) of 97 IU/L (normal 1047 IU/L). A contrast-enhanced CT of the abdomen was performed (Fig. 1), which revealed pancreatic enlargement and peripancreatic inflammatory changes consistent with acute pancreatitis. The splenic vein was patent at this point.
The patient continued to drink alcohol and went to a different hospital emergency department 22 months later with left-upper-quadrant abdominal pain. Contrast-enhanced CT of the abdomen (Fig. 2) revealed thrombus in...