Case Study

Evaluating for portal vein thrombosis; a forum post.

History of regenerative anemia likely immune mediated, has an elevated ALT and ALP but has also been on prednisone. The patient had a blood transfusion and then developed ascites.
Fluid collected appeared to be a modified transudate, no mass lesions, hyperechoic hepatomegaly. Concerns about possible portal vein thrombosis.

Great case and nice pv thrombus!! The only ones I ever get to see on follow-up have been treated with plasma and plavix. AIHA and ITP/Evans cases are classic for this. But be sure its not paraneoiplastic like lymphoma lurking somewhere. Here are a few similar cases form the basic search: http://sonopath.com/members/case-studies/search?text=portal+thrombosis&s…
Plavix, plasma and recheck Q 72 hours on sonogram and you will know clinically if its working because the ascites will go away as will the abdominal bloating.

Forum post: https://sonopath.com/forum/evaluating-portal-vein-thrombosis#comment-2011

Comments

Here is a good article on it as well:

J Vet Intern Med 2012 Portal Vein Thrombosis in 33 Dogs: 1998–2011 M. Respess, T.E. O’Toole, O.Taeymans, C.L. Rogers, A. Johnston, and C.R.L. Webster

Background: Portal vein thrombosis (PVT) has been reported infrequently in dogs.
Objectives: To characterize the presentation, associated disease conditions, and outcome in dogs with PVT.
Animals: Client-owned dogs with a diagnosis of PVT and a complete medical record.
Methods: Records were retrospectively analyzed for presentation, history, physical examination, clinicopathologic data,
diagnostic imaging, treatment, and outcome.
Results: Thirty-three dogs were included. Common clinical signs were vomiting, diarrhea, abdominal pain, ascites, and
signs of hypovolemic shock. Associated disease conditions included hepatic (14/33), neoplastic (7/33), immune (5/33), and infectious (4/33) diseases, protein-losing nephropathy (3/33), hyperadrenocorticism (2/33), protein-losing enteropathy [PLE] (1/33), and pancreatitis (1/33). Fourteen dogs were receiving glucocorticoids at the time of diagnosis. Twenty-nine dogs had at least 1 predisposing condition for venous thrombosis, and 11 had 2 or more. Thrombocytopenia (24/33), increased liver enzyme activity (23/33), and hypoalbuminemia (20/33) were common laboratory abnormalities. Clinical syndromes at the time of PVT diagnosis included shock (16/33), systemic inflammatory response syndrome (SIRS), (13/33) and dissemi- nated intravascular coagulation (3/33). Twenty-four dogs had acute and 9 had chronic PVT. Multiple thrombi were found in 17/33 dogs. Nineteen dogs survived to discharge. Dogs treated with anticoagulant therapy were more likely, whereas those with acute PVT, multiple thromboses or SIRS were less likely to survive.
Conclusions and Clinical Importance: Hepatic disease is a common pre-existing condition in dogs with PVT. PVT should be considered in dogs with risk factors for venous thrombosis presenting with abdominal pain, ascites, and thrombocytopenia. Studies evaluating anticoagulant therapy in the management of PVT are warranted.
Key words: Coagulation; Coagulopathy; Liver disease; Thromboembolism.