Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 463-468
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.463
Sinistral portal hypertension associated with pancreatic pseudocysts - ultrasonography findings: A case report
Bei-Bei Chen, Pei-Yuan Mu, Jing-Tai Lu, Gong Wang, Rui Zhang, Dan-Dan Huang, Dong-Hua Shen, Ting-Ting Jiang
Bei-Bei Chen, Department of Ultrasound, Postgraduate Training Base of Jinzhou Medical University, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
Pei-Yuan Mu, Jing-Tai Lu, Gong Wang, Rui Zhang, Dan-Dan Huang, Dong-Hua Shen, Ting-Ting Jiang, Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
Author contributions: Chen BB reviewed and searched the literatures, analyzed and interpreted the imaging findings, rafted the manuscript and gave critical comments; Mu PY, co-first author, contributed equally to this work; and other authors gave critical comments.
Informed consent statement: Informed written 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 conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Pei-Yuan Mu, MD, PhD, Chief Physician, Department of Ultrasound, The PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekouwai Street, Beijing 100088, China. pymu@sina.com
Received: August 24, 2020
Peer-review started: August 24, 2020
First decision: November 3, 2020
Revised: November 16, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021
Abstract
BACKGROUND

Sinistral portal hypertension associated with pancreatic pseudocysts is rare, often caused by extrinsic compression of splenic vein, the follow-up examinations by ultrasonography for early diagnosis are quietly necessary since haematemesis, a life-threatening condition. Few studies have reported the ultrasonography findings of sinistral portal hypertension.

CASE SUMMARY

A 52-year-old man presented with acute abdominal pain after drinking, steatorrhea, weight loss and accidentally melena in the past 2 mo. He underwent ultrasound-guided fine needle aspiration in other hospital and diagnosed with pancreatic pseudocysts. Ultrasonography imaging, in our department, appeared as cystic heterogeneous hypoechoic area with the size of 4.7 cm × 3.8 cm that located posterior to the body and tail of pancreas, adjacent to splenic vein associated with thrombosis resulted from compression. Spleen incrassated to approximately 7.3 cm, but no dilation of main portal vein was presented. Color Doppler Flow Imaging demonstrated the formation of splenic venous collateral, nevertheless no significantly flow signals was observed in splenic vein. Pulsed Doppler revealed that the peak velocity of splenic venous collateral was 18.4 cm/s with continuous waveform. Laparotomy confirmed sinistral portal hypertension associated with pancreatic pseudocysts, subsequently distal pancreatectomy combined with splenectomy and partial gastrectomy was performed.

CONCLUSION

It’s important clinically to know the ultrasound appearance of sinistral portal hypertension associated with pancreatic pseudocysts for sonographer and physician.

Keywords: Sinistral portal hypertension, Pancreatic pseudocysts, Ultrasonography imaging, Upper gastrointestinal hemorrhage, Splenic vein, Case report

Core Tip: Sinistral portal hypertension associated with pancreatic pseudocysts is rare, caused by compression of splenic vein, the follow-up examinations by ultrasonography for early diagnosis are quietly necessary since haematemesis, a life-threatening condition, which highlights the significance of ultrasonography imaging.