Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

Figure 4 Case 4: A 42-year-old man with abdominal pain, diarrhea, and nausea for 2 wk. He had undergone splenectomy 4 wk previously. A: Selected axial image from admission contrast-enhanced CT demonstrates massive thrombus within the proximal of SMV (arrow) and the stump of the splenic vein (curved arrow); B: Pre-treatment direct venography via transjugular approach access to the portal vein showing extensive PV-SMV thrombosis (arrows), without collateral drainage; C: Immediate follow-up direct portal venography after catheter fragmentation and aspiration of the PV-SMV thrombosis, shows 75% reduction of thrombosis in the SMV and PV (arrow). The catheter infusion of thrombolytics was continued for 4 d and further improvement was confirmed by CT follow-up; D: Contrast-enhanced CT image at the same level as in Figure 4A obtained 5 d after completion of the interventional procedure shows a wide patent SMV (arrows).