Septic thrombophlebitis of the portal venous system: clinical and imaging findings in thirty-three patients.

AIM: Our purpose was to review the clinical and imaging findings in a series of patients with septic thrombophlebitis of the portal venous system in order to define criteria that might allow more confident and timely diagnosis.

MATERIALS AND METHODS: This is a retrospective case series. The clinical and imaging features were analyzed in 33 subjects with septic thrombophlebitis of the portal venous system.

RESULTS: All 33 patients with septic thrombophlebitis of the portal venous system had pre-disposing infectious or inflammatory processes. Contrast-enhanced CT studies of patients with septic thrombophlebitis typically demonstrate an infectious gastrointestinal source (82%), thrombosis (70%), and/or gas (21%) of the portal system or its branches, and intrahepatic abnormalities such as a transient hepatic attenuation difference (THAD) (42%) or abscess (61%).

CONCLUSIONS: Septic thrombophlebitis of the portal system is often associated with an infectious source in the gastrointestinal tract and sepsis. Contrast-enhanced CT demonstrates an infectious gastrointestinal source, thrombosis or gas within the portal system or its branches, and intrahepatic abnormalities such as abscess in most cases. We report a THAD in several of our patients, an observation that was not made in prior reports of septic thrombophlebitis.