Superior Mesenteric Vein Thrombosis with Radiologically Occult Cause
A Retrospective Study of 43 Cases
David M. Warshauer1,
Joseph K. T. Lee1,
Matthew A. Mauro1 and
Gilbert C. White, II2
1
Department of Radiology, University of North Carolina School of Medicine,
Campus Box 7510, Rm. 2016, Old Clinic Bldg., Manning Dr., Chapel Hill, NC
27599-7510.
2
Division of Hematology, Department of Medicine, University of North Carolina
School of Medicine, Chapel Hill, NC 27599-7510.
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Fig. 1. —51-year-old man with superior mesenteric vein thrombosis 32
days after total abdominal colectomy with J pouch creation and ileal-anal
anastomosis performed for ulcerative colitis. Contrast-enhanced axial CT image
shows central clot in superior mesenteric vein (arrow). No mesenteric
congestion is noted. Patient's only symptoms were referable to small peripouch
infection. No therapy was undertaken for clot, and patient recovered without
ischemia.
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Fig. 2A. —57-year-old women with superior mesenteric, portal, and
splenic vein thrombosis 16 days after splenectomy. Patient also had
thrombocytosis and urinary tract infection and was taking estrogen.
Contrast-enhanced axial CT scan shows clot in portal (solid arrow)
and splenic veins (open arrow).
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Fig. 2B. —57-year-old women with superior mesenteric, portal, and
splenic vein thrombosis 16 days after splenectomy. Patient also had
thrombocytosis and urinary tract infection and was taking estrogen.
Contrast-enhanced axial CT scan shows clot in superior mesenteric vein
(arrow).
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Fig. 2C. —57-year-old women with superior mesenteric, portal, and
splenic vein thrombosis 16 days after splenectomy. Patient also had
thrombocytosis and urinary tract infection and was taking estrogen.
Contrast-enhanced axial CT scan reveals mild inflammatory and congestive
changes around superior mesenteric vein and root of mesentery
(arrows). Patient was treated with anticoagulation and transcatheter
clot lysis and recovered without bowel ischemia.
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Fig. 3. —25-year-old man with superior mesenteric vein thrombus and
sickle cell disease 14 days after splenectomy. Patient also had thrombocytosis
and was heterozygous for factor V Leiden. Contrast-enhanced CT image shows
clot occluding superior mesenteric vein (solid straight arrow), with
mesenteric congestion (open arrow) and bowel wall thickening
(curved arrow). Patient was treated with anticoagulation and
recovered without bowel ischemia.
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Fig. 4A. —20-year-old man with appendicitis and superior mesenteric and
portal vein thrombosis. Contrast-enhanced axial CT image shows intrahepatic
portal vein clot (arrow) with compensatory hyperenhancement
(arrowheads) in liver.
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Fig. 4B. —20-year-old man with appendicitis and superior mesenteric and
portal vein thrombosis. Contrast-enhanced axial CT image shows occluded
superior mesenteric vein (arrow). Patient was treated with
anticoagulation and antibiotics and recovered uneventfully. He later underwent
interval appendectomy.
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Fig. 5. —52-year-old man with superior mesenteric vein thrombosis and
no known risk factors. Coronal MR image (T1-weighted, fat-saturated,
contrast-enhanced) shows extensive clot (arrow) in superior
mesenteric vein. Patient was treated with anticoagulation and transcatheter
clot lysis and recovered without bowel ischemia.
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Copyright © 2001 by the American Roentgen Ray Society.
