Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment

Table 4 AASLD recommendations for diagnosis of acute and chronic PVT[126]

AASLD recommendations for diagnosis of acute PVT	AASLD recommendations for diagnosis of chronic PVT
Consider a diagnosis of acute PVT in any patient with abdominal pain of more than 24 h duration, whether or not there is also fever or ileus	Consider a diagnosis of chronic PVT in any patient with newly diagnosed portal hypertension
If acute PVT is suspected, computed tomography (CT) scan, before and after injection of vascular contrast agent, should be obtained for early confirmation of diagnosis. If CT scan is not rapidly available, obtain Doppler-sonography	Obtain Doppler-sonography, then either CT scan or MRI, before and after a vascular contrast agent, to make a diagnosis of chronic PVT
In patients with acute PVT and high fever, septic pylephlebitis should be considered, whether or not an abdominal source of infection has been identified, and blood cultures should be routinely obtained	Base the diagnosis on the absence of a visible normal portal vein and its replacement with serpiginous veins
In acute PVT, the possibility of intestinal infarction should be considered from presentation until resolution of pain. The presence of ascites, thinning of the intestinal wall, lack of mucosal enhancement of the thickened intestinal wall, or the development of multiorgan failure indicate that intestinal infarction is likely and surgical exploration should be considered