Portal and hepatic vein thrombosis in liver abscess: CT findings.
OBJECTIVE
Our aim is to describe imaging findings of portal and hepatic vein thrombosis in pyogenic liver abscess on contrast-enhanced MDCT and to determine the incidence and evolving patterns on follow-up imaging.


METHODS
Over a 5-year period, 67 patients with liver abscess underwent single-phase (n=30) or triphasic (n=37) contrast-enhanced CT. Images were reviewed for the presence of portal vein (PV) or hepatic vein (HV) thrombosis, regional parenchymal attenuation, and changes on follow-up CT.


RESULTS
Venous thrombosis was seen in 28/67 patients (42%), involving PV in 16/67 (24%) and HV vein in 15/67 (22%); 3/67 (4%) had both PV and HV thrombosis. Thrombosis was seen as non-enhancing linear structures without expanding the lumen in all cases. Regional parenchymal attenuation during the portal-phase was hyperattenuating (10/16, 63%) or isoattenuating (6/16, 38%) in PV thrombosis, and mostly hypoattenuating (13/15, 87%) in HV thrombosis (P<.001). Of 27 patients with follow-up contrast-enhanced CT, venous thrombosis resolved in 10/27 (37%) within 6 months and persisted in 17/27 (63%) for 3-38 months, including 13 PV thrombosis and 4 HV thrombosis. Interval parenchymal atrophy was seen only in four all with persistent PV thrombosis.


CONCLUSIONS
Both PV and HV thrombosis frequently occurs in liver abscess and is seen as non-enhancing linear structures without expanding the lumen on contrast-enhanced CT. Regional attenuation changes in hepatic vein thrombosis were often hypoattenuating whereas none with portal vein thrombosis showed hypoattenuation.
Syed
Mohammed Aejaz
MA
Department of Medical Imaging, University Health Networks and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. smaejaz@hotmail.com
Kim
Tae Kyoung
TK
Jang
Hyun-Jung
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology
D003287:Contrast Media