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Rational classification of portal vein thrombosis and its clinical significance.

Ma J, Yan Z, Luo J, Liu Q, Wang J, Qiu S - PLoS ONE (2014)

Bottom Line: Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001).The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001).In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.

ABSTRACT
Portal vein thrombosis (PVT) is commonly classified into acute (symptom duration <60 days and absence of portal carvernoma and portal hypertension) and chronic types. However, the rationality of this classification has received little attention. In this study, 60 patients (40 men and 20 women) with PVT were examined using contrast-enhanced computed tomography (CT). The percentage of vein occlusion, including portal vein (PV) and superior mesenteric vein (SMV), was measured on CT image. Of 60 patients, 17 (28.3%) met the criterion of acute PVT. Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001). However, there was no significant difference in PV occlusion between patients with and without symptoms. The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001). Complications of portal hypertension were significantly associated with cirrhosis (p<0.001) rather than with the severity of PVT and presence of cavernoma. These results suggest that the severity of PVT is only associated with the formation of portal cavernoma but unrelated to the onset of symptoms and the development of portal hypertension. We classified PVT into complete and partial types, and each was subclassified into with and without portal cavernoma. In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT. The new classification system can determine the pathological alterations of PVT, patency of portal vein and outcome of treatment in a longitudinal study.

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Comparison of symptom duration between PVT patients with and without portal cavernoma.There was no significant difference in symptom duration between two groups.
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pone-0112501-g001: Comparison of symptom duration between PVT patients with and without portal cavernoma.There was no significant difference in symptom duration between two groups.

Mentions: Of 60 patients, 33 had recent onset of symptoms (symptom duration: 0–37 days prior to diagnosis) and 21 were asymptomatic (Table 1). In these 2 groups, the severity of PVT and the presence of portal cavernoma were not significantly associated with symptom onset (Table 1). There was no significant difference in PV lumen occlusion between patients with and without symptoms. In patients with recent onset of symptoms, there was no significant difference in symptom duration between subjects with and without portal cavernoma (mean duration: 8.40 vs 10.6 days)(Fig 1). However, symptoms occurred significantly more frequent in patients with SMVT than those without SMVT (p<0.001)(Table 1). In patients with SMVT, the SMV lumen occlusion was significantly increased in the subjects with recent symptoms (SMV occlusion 85.5±13.3%) compared to those without symptom (SMV occlusion 65.8±27.9%)(p<0.05)(Fig 2). Logistic analysis demonstrated that the likelihood of symptom onset was 13.3 times (Odds ratio  = 13.3, 95%CI: 3.07–57.9, p<0.001) higher in patients with SMVT than those without SMVT. According to the criteria of classification, 17 patients (28.3%), who experienced recent onset of symptoms but had no portal cavernoma and complication of portal hyertension, were defined as acute PVT and 43 others (71.7%) were defined as chronic PVT (Table 2).


Rational classification of portal vein thrombosis and its clinical significance.

Ma J, Yan Z, Luo J, Liu Q, Wang J, Qiu S - PLoS ONE (2014)

Comparison of symptom duration between PVT patients with and without portal cavernoma.There was no significant difference in symptom duration between two groups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231054&req=5

pone-0112501-g001: Comparison of symptom duration between PVT patients with and without portal cavernoma.There was no significant difference in symptom duration between two groups.
Mentions: Of 60 patients, 33 had recent onset of symptoms (symptom duration: 0–37 days prior to diagnosis) and 21 were asymptomatic (Table 1). In these 2 groups, the severity of PVT and the presence of portal cavernoma were not significantly associated with symptom onset (Table 1). There was no significant difference in PV lumen occlusion between patients with and without symptoms. In patients with recent onset of symptoms, there was no significant difference in symptom duration between subjects with and without portal cavernoma (mean duration: 8.40 vs 10.6 days)(Fig 1). However, symptoms occurred significantly more frequent in patients with SMVT than those without SMVT (p<0.001)(Table 1). In patients with SMVT, the SMV lumen occlusion was significantly increased in the subjects with recent symptoms (SMV occlusion 85.5±13.3%) compared to those without symptom (SMV occlusion 65.8±27.9%)(p<0.05)(Fig 2). Logistic analysis demonstrated that the likelihood of symptom onset was 13.3 times (Odds ratio  = 13.3, 95%CI: 3.07–57.9, p<0.001) higher in patients with SMVT than those without SMVT. According to the criteria of classification, 17 patients (28.3%), who experienced recent onset of symptoms but had no portal cavernoma and complication of portal hyertension, were defined as acute PVT and 43 others (71.7%) were defined as chronic PVT (Table 2).

Bottom Line: Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001).The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001).In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.

ABSTRACT
Portal vein thrombosis (PVT) is commonly classified into acute (symptom duration <60 days and absence of portal carvernoma and portal hypertension) and chronic types. However, the rationality of this classification has received little attention. In this study, 60 patients (40 men and 20 women) with PVT were examined using contrast-enhanced computed tomography (CT). The percentage of vein occlusion, including portal vein (PV) and superior mesenteric vein (SMV), was measured on CT image. Of 60 patients, 17 (28.3%) met the criterion of acute PVT. Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001). However, there was no significant difference in PV occlusion between patients with and without symptoms. The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001). Complications of portal hypertension were significantly associated with cirrhosis (p<0.001) rather than with the severity of PVT and presence of cavernoma. These results suggest that the severity of PVT is only associated with the formation of portal cavernoma but unrelated to the onset of symptoms and the development of portal hypertension. We classified PVT into complete and partial types, and each was subclassified into with and without portal cavernoma. In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT. The new classification system can determine the pathological alterations of PVT, patency of portal vein and outcome of treatment in a longitudinal study.

Show MeSH
Related in: MedlinePlus