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A case of idiopathic portal vein thrombosis?
  1. R D Johnston1,
  2. C Chang2,
  3. R K Singh3,
  4. A Austin4
  1. 1
    Nottingham Digestive Diseases Centre and Biomedical Research Unit, University Hospital, Nottingham, UK
  2. 2
    Department of Haematology, Royal Derby Hospital, Uttoxeter Road, Derby, UK
  3. 3
    Department of Radiology, Royal Derby Hospital, Uttoxeter Road, Derby, UK
  4. 4
    Derby Digestive Diseases Centre, Royal Derby Hospital, Uttoxeter Road, Derby, UK
  1. Correspondence to Dr R D Johnston, Wolfson Digestive Diseases Centre, University Hospital, Nottingham NG7 2UH, UK; rjohnston75{at}doctors.org.uk

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Clinical presentation

A 21-year-old Caucasian male presented with a short history of epigastric pain and weight loss. Physical examination revealed splenomegaly only. Renal biochemistry and full blood count were normal. There were minor elevations in liver enzymes. A contrast-enhanced abdominal CT scan identified splenomegaly with infarcts, and portal and splenic vein thrombosis without cavernoma formation (figs 1 and 2). A thrombophilia screen comprising anticardiolipin immunoglobulin G (IgG) and lupus anticoagulant, factor V Leiden and prothrombin gene mutation analysis, protein C and S quantification and screening for paroxysmal nocturnal haemoglobinuria was normal. Bone marrow architecture was normal, with a non-significant increase in megakaryocyte count. The BCR-ABL oncogene was absent.

Figure 1

Contrast-enhanced axial CT scan of the abdomen in portal venous phase. The arrows indicate …

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