Diagnosis of Portal Vein Thrombosis

Blood tests. These can detect acquired and hereditary thrombophilic factors.

Abdominal Doppler ultrasound. This is the first imaging test performed when portal vein thrombosis is suspected. Sound waves are used to create images of the blood vessels and observe how blood flows through them. It can detect a clot blocking the portal vein or other veins in the abdomen. This is a fast, non-invasive and effective test to identify blood flow problems.

CT and MR Angiography These are imaging tests to diagnose a thrombosis in the portal vein or mesenteric veins. These tests help to:

• Confirm a diagnosis. They clearly identify if there is a clot blocking a vein.
• Evaluate the extension. They show which veins are affected and if the clot has spread.
• Detect signs of chronicity. They can show if the thrombosis is recent or has been present for some time.
• Look for local factors. They show possible factors related to the formation of the clot, such as inflammation or infections in the abdomen.

Liver elastography. A test that measures liver stiffness using sound waves. Increased stiffness may be a sign of liver disease, such as fibrosis or cirrhosis. This test is useful for evaluating liver condition without the need for a biopsy.

Gastroscopy. A flexible tube with a camera is inserted to examine the inside of the oesophagus and stomach. It is used to rule out the presence of oesophageal or gastric varices, which are dilated veins that can appear in patients with portal vein thrombosis or portal hypertension. If these varices rupture, they can cause serious bleeding, so early detection is important.