Hepatic Infarction Caused by Portal Vein Thrombophlebitis Misdiagnosed as Infiltrative Hepatic Malignancy with Neoplastic Thrombus

Minjung Shim; Tae Young Yang; Nam Gil Cho; Ara Woo; Eunju Kim; Keunhoi Park; Joo Ho Lee; Yun Bin Lee; Seong Gyu Hwang; Kyu Sung Rim; Hana Park

doi:10.4166/kjg.2016.68.3.156

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Shim, Yang, Cho, Woo, Kim, Park, Lee, Lee, Hwang, Rim, and Park: Hepatic Infarction Caused by Portal Vein Thrombophlebitis Misdiagnosed as Infiltrative Hepatic Malignancy with Neoplastic Thrombus

Case Report

Korean J Gastroenterol 2016;68(3):156-160.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.3.156

Hepatic Infarction Caused by Portal Vein Thrombophlebitis Misdiagnosed as Infiltrative Hepatic Malignancy with Neoplastic Thrombus

Minjung Shim¹, Tae Young Yang¹, Nam Gil Cho¹, Ara Woo¹, Eunju Kim¹, Keunhoi Park¹, Joo Ho Lee^1,², Yun Bin Lee^1,², Seong Gyu Hwang^1,², Kyu Sung Rim^1,², Hana Park^1,²

¹Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea

²Division of Gastroenterology and Hepatology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Correspondence to: Hana Park, Department of Internal Medicine, Division of Gastroenterology and Hepatology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: +82-31-780-5219, Fax: +82-31-780-4927, E-mail: phn223@cha.ac.kr

Received 31 March 2016 Revised 19 July 2016 Accepted 19 July 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Portal vein thrombosis (PVT) is a form of venous thrombosis that usually presents in chronic form without any sequalae in patients with hepatocellular carcinoma (HCC) or liver cirrhosis. Accurate differential diagnosis of bland PVT from neoplastic PVT is an important step for planning treatment options, but the acute form can be challenging. Here we present a case of acute hepatic infarction caused by acute bland PVT combined with pylephlebitis, which was misdiagnosed as infiltrative hepatic malignancy with neoplastic PVT owing to the perplexing imaging results and elevated tumor markers.

Keywords: Chronic hepatitis B, Tenofovir, Portal vein, Thrombophlebitis

References

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Fig. 1.

Portal vein (PV) thrombosis on imaging studies. Suspiciously infiltrative and hypovascular hepatocellular carcinoma on S8 of markedly shrunken liver parenchyma with enhanced thrombosis (arrows) at right PV and main PV on CT scans. (A) Liver MRI revealed portal vein thrombosis on contrast enhanced fat suppression T1 portal phase (B), enhancement on early arterial phase of dynamic enhanced study (C), and on hepatobiliary phase (D).

Fig. 2.

Acute hepatic infarction on liver MRI. Liver MRI at first visit showed ill-defined and slightly T2 high signal intensity lesion (arrows) on S8 of liver (A) and sustained high signal intensity on diffusion weighted imaging. (B) The lesion was not demarcated well on enhanced early arterial phase of dynamic study (C) or on hepatobiliary phase because of markedly decreased liver function (D).

Fig. 3.

Liver tumor CT after 12 months showed a remaining wedge-shaped non-enhanced low attenuated lesion (arrow) on S8 of liver (A) and chronic partial thrombi (benign thrombi) (arrow) at anterior branch of right portal vein (PV) and main PV with arterioportal shunts (B).

Fig. 4.

Serial changes of serum CA 19–9 and AFP levels.

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