Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2019; 11(2): 234-241
Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.234
Acute portal vein thrombosis after liver transplant presenting with subtle ultrasound abnormalities: A case report and literature review
Thomas Couri, Carla Harmath, Talia Baker, Anjana Pillai
Thomas Couri, Department of Internal Medicine, University of Chicago, Chicago, IL 60637, United States
Carla Harmath, Department of Radiology, University of Chicago, Chicago, IL 60637, United States
Talia Baker, Department of Surgery, Section of Transplant Surgery, University of Chicago, Chicago, IL 60637, United States
Anjana Pillai, Department of Internal Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL 60637, United States
Author contributions: Couri T and Pillai A designed the report; Couri T and Harmath C collected the patient’s data; Harmath C, Baker T, and Pillai A provided critical revision of the report; Couri T and Pillai A wrote the report.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Thomas Couri, MD, Department of Internal Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, United States. thomas.couri@uchospitals.edu
Telephone: +1-773-7021000 Fax: +1-773-7022230
Received: October 7, 2018
Peer-review started: October 7, 2018
First decision: November 15, 2018
Revised: November 27, 2018
Accepted: December 12, 2018
Article in press: December 13, 2018
Published online: February 27, 2019
Abstract
BACKGROUND

Portal vein thrombosis (PVT) after liver transplantation (LT) is an uncommon complication with potential for significant morbidity and mortality that transplant providers should be cognizant of. Recognizing subtle changes in post-operative ultrasounds that could herald but do not definitively diagnose PVT is paramount.

CASE SUMMARY

A 30-year-old female with a history of alcohol-related cirrhosis presented with painless jaundice and received a deceased donor orthotopic liver transplant. On the first two days post-operatively, her liver Doppler ultrasounds showed a patent portal vein, increased hepatic arterial diastolic flows, and reduced hepatic arterial resistive indices. She was asymptomatic with improving labs. On post-operative day three, her resistive indices declined further, and computed tomography of the abdomen revealed a large extra-hepatic PVT. The patient then underwent emergent percutaneous venography with tissue plasminogen activator administration, angioplasty, and stent placement. Aspirin was started to prevent stent thrombosis. Follow-up ultrasounds showed a patent portal vein and improved hepatic arterial resistive indices. Her graft function improved to normal by discharge. Although decreased hepatic artery resistive indices and increased diastolic flows on ultrasound are often associated with hepatic arterial stenosis post-LT, PVT can also cause these findings.

CONCLUSION

Reduced hepatic arterial resistive indices on ultrasound can signify PVT post-LT, and thrombolysis, angioplasty, and stent placement are efficacious treatments.

Keywords: Portal vein thrombosis, Portal vein stent, Liver transplant, Case report

Core tip: Acute portal vein thrombosis (PVT) after liver transplant is uncommon but can cause significant morbidity and mortality. PVT can present with subtle ultrasound abnormalities in the hepatic artery, such as decreased resistive indices and increased diastolic flows, in the absence of frank thrombosis in the portal vein. Long term portal vein patency has been seen with percutaneous thrombolysis, angioplasty, and stent placement as treatment.