1. Case presentation: Dr. Mohammad Shaikhani. Dr. Mohammad Omer Mohammad. Sulaimanyah University. College of Medicine. Department of Medicine.
2. SH.K, 20 years old, Studen from Darbandixan,Sulaimanyiah, Iraq. Date of admission: 9.9.08 CC: abdominal distention for the last 2 weeks H.P.I: a female with abdominal distention and yellow discoloration of skin and sclera associated with pain during voiding and frequency with lower pelvic pain. There were no fever no rigor. P.M.H: not significant D.H: on HRT for irregular cycles. There is no Hx of blood transfusion, tattooing or drug injection “ addiction ”
3. Review of systems: Resp: SOB, no cough no sputum CVS: no palpitation, no leg edema. GIT: decr. Appetite, nausea, constipation. O/E: conscious oriented young lady Ting of jaundice, no cyanosis … mild pallor Chest: clear, N.V.B Precordium: NDR, no added sounds Abdomen: soft, hepatospleenomegally Ascitis with +ve shifting dullness and trans thrill Neurology: intact Vita signs …
8. S Pr. Elec: AlB: normal 58.20 Alpha 1: low 0.07 Alpha 2: low 3.65 Beta: low 6.62 Gama: high 31.46 Total: 8.20 gm/dl A/G : 1.39
9. Doppler study: 1 st : prominent caudate lobe, mild coarse liver texture, nr hepatic flow 2 nd : hepatomegaly, prominent caudate, no focal mass, acute thrombosis of portal and splenic vein. Huge splenomegaly and moderate abdominal Ascitis. Last PT: 24.7 INR: 3
10. Final diagnosis: Portal vein/splenic vein thrombosis due to hypercoagulable state from ?essential throbocythemia potentate by oral contraceptive use.
12. Case 2 52 year old man with a history of PNH originally diagnosed in 1978 (at age 28) when he presented with dark urine and was noted to have moderate hemolytic anemia Treated initially at that time with prednisone and blood transfusions. Had a relatively mild course with infrequent episodes of hematuria and very few blood transfusions Did not see a hematologist for over 20 years
13. Case Presentation Presented in April 2002 with abdominal pain and distension and was noted to be jaundiced Hepatitis workup was negative but an MRI of the abdomen revealed hepatic vein thrombosis (Budd-Chiari syndrome) Underwent a transjugular liver biopsy on 4/23/02 which revealed extensive fibrosis, no cirrhosis, sinusoidal dilatation and central vein fibrosis consistent with Budd-Chiari syndrome Despite anticoagulation and numerous paracenteses, refractory ascites was present and he underwent a TIPS procedure in 7/02
14. Case Presentation Patient subsequently developed hepatic encephalopathy, requiring multiple hospital admissions over 2 months following TIPS placement Ultrasounds confirmed patency of shunt Referred to Dr Bessler in 9/02. Evaluation revealed a jaundiced, mildly encephalopathic man with normal abdomen CBC revealed Hgb 11.9 with MCV 97.2, plt cnt 90,000, ANC 2,700, INR 1.7, creatinine 0.8, and bilirubin 6
24. Vascular diseases of the liver; Budd-chiari/portal vein thrombosis& other veno-occlusive disorders: Conditions in which radiologists & interventional radiologists can contribute much. Prepared by: Dr.Mohammad Shaikhani. [email_address]