Detection of benign and malignant portal vein thrombosis in cirrhosis and hepatocellular carcinoma by echo-doppler study

Patients with cirrhosis are at a much greater risk of developing benign or malignant portal vein thrombosis [PVT]. Most benign PVT occurs because of the development of portal venous hypertension and venous stasis, while malignant PVT occurs by direct invasion of the portal vein by hepatocellular carcinoma [HCC]. To assess and evaluate the use of color Doppler technique in detecting PVT and diagnosing its nature in cirrhotic and in HCC patients, and to find out the distinguishing features of patients with benign from patients with malignant PVT. Fifty male patients with HCC and 10 male cirrhotic patients were enrolled in the study, together with 10 age and sex matched volunteers as controls. Complete clinical examination, liver function tests, serum alpha fetoprotein [AFP] levels, and abdominal ultrasonography was carried out for each participant. Color echo-Doppler study to detect PVT was performed for all patients using a Toshiba Ecco-C machine; pulsatile intrathrombus blood flow was used as an indicator of the malignant nature of the thrombus. The echo-Doppler scanning revealed the presence of PVT in 10/50 HCC patients [20%], while the presence of intrathrombus hepatofugal pulsatile blood flow was detected in 7/10 [70%], indicating malignant PVT. Continuous hepatopetal blood flow was detected in 3/10 HCC [30%] and in one out of 10 cirrhotic patients [10%], indicating benign PVT. Patients with malignant PVT had ascites [60%], placed in Child's class C [40%], and serum AFP level 400 ng/ml [70%].

As the clinical picture and prognosis of patients with cirrhosis and patients with HCC could be affected by the occurrence of PVT, therefore, whenever suspected, echo-Doppler should be performed as it could be considered a useful mean of screening for PVT, in addition, the detection of pulsatile intrathrombus blood flow could be an indicator of its malignant nature