Case 329 Medical history Male patient, 56 years old, chronic carrier of hepatitis C virus (HCV), liver cirrhosis (Child-Pugh B7 and MELD 14) was subjected to antiviral therapy with sustained virological response (undetectable HCV-RNA). In the follow-up, abdominal ultrasonography showed a cavernomatous transformation of the portal vein and intravascular echogenic material. After an episode of moderate ascites (grade 2), he underwent a computed tomography (CT) of the abdomen and pelvis to evaluate the portal circulation. Computed tomography (CT) of the abdomen and pelvis, arterial phase, coronal reconstruction, maximum intensity projection (MIP), portal vein level and splenomesenteric confluence.Computed tomography (CT) of the abdomen and pelvis, portal phase, sagittal reconstruction, maximal intensity projection (MIP), splenic cord level.Computed tomography (CT) of the abdomen and pelvis, portal phase, coronal reconstruction, level of the splenic hilum. Question:Based on the clinical history and the presented images, what would be the most likely clinical diagnosis of altered portal circulation? Chronic portal vein thrombosis. Acute portal vein thrombosis. Budd-Chiari Syndrome. Hepatocellular carcinoma. Test Question (UNIFESP - 2016) About the hepatic vascular diseases can be said, EXCEPT: The chronic form is more commonly found in patients with Budd-Chiari syndrome. Budd-Chiari syndrome is often associated with prothrombotic conditions, myeloproliferative diseases being the most common cause. Anticoagulation is recommended for all cases of acute portal thrombosis unrelated to cirrhosis and should be considered in all cirrhotic patients with acute not-tumoral portal thrombosis. Changes that suggest acute portal vein thrombosis: cavernomatous transformation, presence of collateral circulation, and focus of calcification. Signs suggestive of portal vein tumor thrombosis: portal vein caliber greater than 2 cm and endoluminal staining during the arterial phase of contrast injection. Time is Up! Time's up
