ABSTRACT
Objective@#Portal vein thrombosis (PVT) is a rare and severe clinical manifestation of antiphospholipid syndrome (APS), as well as a predictor of poor prognosis. This study was conducted to explore the clinical features and risk factors of PVT in APS patients.@*Methods@#A total of 123 APS patients diagnosed from 2012 to 2019 were retrospectively enrolled. The diagnosis of PVT was made according to the 2009 American College of Liver Diseases (AASLD) criteria. Clinical and laboratory data were collected. A multivariate (MV) logistic regression model was constructed using a stepwise forward selection procedure among those candidate univariables with P values<0.10.@*Results@#A total of 28 cases with PVT, and 95 control cases without PVT were finally enrolled.The 28 APS-PVT patients included 5 males and 23 females with age range from 17 to 63 years. Clinical manifestations included acute thrombosis in 8 patients, chronic thrombosis in 16, and 4 with portal vein spongiform. As to the involved vessels, single portal vein thrombosis was seen in 20 patients, portal combined with superior mesenteric vein (SMV) and splenic vein in one patient, portal plus SMV in 4 and only SMV in 3 patients. Other manifestations were portal hypertension (16/28), esophageal varices (13/28), spleen infarction (7/28) and gastrointestinal bleeding (4/28). Two antiphospholipid antibodies were positive in 13 cases. Triple positive antibodies were seen in 7 cases. Multivariate logistic regression analysis showed that disease duration less than 0.5 years (OR=72.74, 95%CI 7.50-705.45, P<0.001), hypoalbuminemia (OR=356.45, 95%CI 19.19-6 620.14, P<0.001), and elevated erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) (OR=14.41, 95%CI 1.49-139.20, P<0.001) were independent risk factors for PVT in APS.@*Conclusion@#PVT is usually misdiagnosed due to insidious onset. Short disease duration, hypoalbuminemia and elevated ESR/CRP are risk factors for PVT in APS. Better understanding, early diagnosis and treatment will improve the clinical outcome.
ABSTRACT
Objective To study the portal venous systemic thrombosis (PVST) in early acute pancreatitis (AP) and its correlations with the classification and severity of AP. Methods A total of 396 patients with AP were admitted to the affiliated hospital of north sichuan medical college from January 2013 to May 2017 and underwent MRI in the early stage of AP. PVST was evaluated on the T1WI, T2WI fat-suppression, and dynamic-enhancement sequences. Evaluating the MR imaging, AP was graded as mild, moderate, and severe AP based on the MR severity index (MRSI) and was also classified into interstitial edematous AP and necrotizing AP. According to the New Revised Classification of AP 2012, AP in the clinic setting was graded as mild, moederately severeand severe AP. χ2 test or Fisher exact test calculated the differences of the prevalence of PVST in different severity and classification of AP, Mann-Whitney U test calculated the difference of hospitalization time between patients with PVST and those without PVST. Results Among the 396 patients with AP, PVST was detected in 30 patients (7.5％,30/396), it formed most frequently in splenic vein(73.3％, 22/30), followed by portal (30.0％, 9/30) and superior mesenteric(16.7％, 5/30) veins. According to MRSI, there were 205, 177, and 14 patients with mild, moderate, and severe AP, respectively;among mild, moderate, and severe AP, there were 2, 21, and 7 patients with PVST, respectively (χ2=41.455, P<0.01), there were also statistical differences in the prevalence of portal and splenic vein thrombosis (P<0.05), but there was no statistical difference in the prevalence of superior mesenteric vein thrombosis (P>0.05). Three hundred and eleven patients had interstitial edematous AP and 65 patients had necrotizing AP, among which there were 11 and 19 patients with PVST(χ2=48.447,P<0.01), the prevalence of portal, splenic and superior mesenteric vein thrombosis in necrotizing AP were all higher than that in interstitial edematous AP (P<0.05). Based on the New Revised Classification of AP 2012, there were 194, 184 and 18 patients with mild, moderately severe, and severe AP, respectively; among mild, moderately severe, and severe AP, there were 0, 25, and 5 patients with PVST, respectively (χ2=42.130, P<0.01), there was no statistical differences in the prevalence of portal, splenic and superior mesenteric vein thrombosis (P>0.05). Patients with PVST and those without PVST in the early AP, the hospitalization time [median (interquartile range)] were 18 (13 to 22) days and 13 (10 to 19) days (Z=-2.913, P=0.004). Conclusion PVST in early AP presented more frequently with the increase in severity of AP based on both the MRSI and Newly Revised Classification of AP 2012, along with longer duration ofhospitalization.
ABSTRACT
Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.