Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis

• Published in: Gastrointestinal radiology Vol. 17; no. 2; p. 135
• Main Authors: Rahmouni, A, Mathieu, D, Golli, M, Douek, P, Anglade, M C, Caillet, H, Vasile, N
• Format: Journal Article
• Language: English
• Published: United States 01.12.1992
• Subjects: Acenocoumarol - therapeutic use; Adult; Female; Heparin - therapeutic use; Humans; Male; Mesenteric Vascular Occlusion - diagnostic imaging; Mesenteric Vascular Occlusion - drug therapy; Mesenteric Veins; Middle Aged; Portal Vein; Splenic Vein; Thrombosis - diagnostic imaging; Thrombosis - drug therapy; Tomography, X-Ray Computed; Ultrasonography
• ISSN: 0364-2356
• DOI: 10.1007/BF01888529

Acute splenoportal and superior mesenteric venous thrombosis were diagnosed on sonography and computed tomography (CT) in six patients. Sonography demonstrated the presence of echoic material filling the involved vessels in all patients. Precontrast CT scans demonstrated an increased, intra luminal density of the clots in four patients with splenoportal thrombosis. However, in two cases of superior mesenteric venous thrombosis, no hyperdensity was observed within the lumens. Nevertheless, the clots were always visualized as low-density regions in the vessel lumens after bolus injection. Intravenous anticoagulant therapy was started immediately after the diagnosis. All patients were evaluated twice a week with sonography and/or CT until recanalization occurred. The patency of the previously involved vessels was assessed from 6 days to 4 weeks after the acute episode (average time of recanalization: 17 days) without development of collateral pathways. It is concluded that, in the absence of clinical signs of a life-threatening process, a conservative management of acute splanchnic thrombosis can be successfully achieved by (1) early diagnosis, (2) efficacious intravenous anticoagulant therapy, (3) careful imaging follow-up of these patients by sonography and/or CT during the acute phase and, finally, (4) by an extensive search for a hypercoagulable state.