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Click 34 year old male with acute onset of hematemesis due to sinistral portal hypertension. Contrast Abdominal CT scan, Protocol: Siemens Sensation 64, 3mm slice thickness, 120 kVp 369 mA, Omnipaque 350, 120 cc) CT demonstrates mild hepatosplenomegaly and spleno-gastric varices. No liver cirrhosis or its sequelae are seen and the varices are only observed in the gastric fundus. There is possibility of an occlusion of a major splenic vessel in the region of pancreatic tail/splenic bed. Closer examination of axial views of the initial CT examination, in light of the findings on mesenteric angiography make proximal splenic vein occlusion/thrombosis the most likely etiology of this patient's presentation with acute upper GI bleed.