Question:

Which of the following answers regarding the detection of pylephlebitis is / are true?
1. An indirect sign for a thrombosis might be a dilatation of a vein.
2. Intrahepatic gas is a clear sign for gas in the portal venous system and thus for pylephlebitis.
3. A thrombosis appears as a central hypodense filling defect with peripheral hyperdensity on enhanced CT images.
4. Complete compressibility is a clear sign for pylephlebitis in color duplex sonography.
5. A mixing artifact can mimic a thrombosis.





Answer:

The correct answers for the question "Which of the following answers regarding the detection of pylephlebitis is / are true?" are:

1. An indirect sign for a thrombosis might be a dilatation of a vein.

3. A thrombosis appears as a central hypodense filling defect with peripheral hyperdensity on enhanced CT images.

5. A mixing artifact can mimic a thrombosis.



Explanation
1., 4.  Color duplex sonography as a contrast-free method can detect the thrombosis as a flow defect, as well as a dilatation (normal IMV diameter: 0,5 cm) and missing compressibility of the vein.

2.  Intrahepatic gas is probably easier to diagnose on plain radiographs but has to be distinguished from biliary air.

3., 5.  With contrast media the filling defect due to the thrombosis can be directly seen on CT / MRI as a central hypodense / hypointense thrombus compared to the peripheral hyperdense / hyperintense contrast media. Differential diagnosis in this constellation includes mixing artifact (contrasted blood mixing with non-contrasted blood).



From the manuscript:
Pylephlebitis of a variant mesenteric vein complicating sigmoid diverticulitis
Radiology Case. 2014 Feb; 8(2):37-45


This article belongs to the GI section.




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From the manuscript

Pylephlebitis of a variant mesenteric vein complicating sigmoid diverticulitis

Free full text article: Pylephlebitis of a variant mesenteric vein  complicating sigmoid diverticulitis

Abstract
Pylephlebitis - suppurative thrombophlebitis of the portal and/or mesenteric veins - is a rare complication of abdominal infections, especially diverticulitis. It can lead to severe complications such as hepatic abscess, sepsis, peritonitis, bowel ischemia, etc., which increase the mortality rate. Here we present a case of suppurative thrombophlebitis of the inferior mesenteric vein, as a complication of sigmoid diverticulitis. The epidemiology, clinical and radiological features as well as treatment strategies are discussed. We also review the anatomy of the mesenteric vein given its anatomic variation in the present case and how this anatomic knowledge might influence the operative approach should surgery be necessary.






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