a 56-year - old fit and healthy gentleman was admitted with symptoms of belching , mild abdominal pain and weight loss of 2 weeks duration . ct also demonstrated filling defects in the portal vein and its intrahepatic main branches consistent with thrombosis and hepatosplenic infarcts ( fig . 1 , fig . 2 , fig . 3 , fig . additional evaluation by magnetic resonance imaging ( mri ) did not reveal any lesion in the porta hepatis . the patient had upper gastrointestinal endoscopy to rule out varices and colonoscopy which did not reveal any lesion . contrast ct and mri demonstrated revascularisation of the previously thrombosed portal vein and resolution of infarcts in the liver and spleen ( fig . portal vein thrombosis ( pvt ) is rare but can occur with any condition predisposing to thrombosis . the population prevalence of pvt is around 1% and mostly secondary to hepatic cirrhosis ( 28% ) . 10% have been implicated with major abdominal infections or inflammatory disease and 3% with myeloproliferative disorder . the signs and symptoms of pvt can be subtle or nonspecific as in our case or they can be overshadowed by those of the underlying illness . abdominal pain , gastrointestinal haemorrhage due to esophageal varices , hepatosplenomegaly , ascites and portal systemic encephalopathy are recognised clinical features . the preferred investigations include duplex ultrasonography and/or colour doppler ultrasonography , ct and magnetic resonance angiography ( mra ) . plain abdominal ultrasound may not be helpful in diagnosing pvt , sometimes clot with variable echogenicity may be depicted in the portal vein . although in most patients ultrasound is the initial investigation , our patient had ct scan of the abdomen first and ultrasound scan of the abdomen later as the sensitivity of thrombus characterisation is reportedly low in ct although if seen it complements the diagnosis . hepatic infarcts usually appear as well - circumscribed , peripheral , wedge - shaped areas of decreased attenuation at ct as in this patient . treatment options include mechanical recanalisation of the portal vein , systemic anticoagulation , local fibrinolysis with or without placement of a transjugular intrahepatic portosystemic stent shunt , combination of mechanical recanalisation and local fibrinolysis and surgical thrombectomy . sheen et al . suggest that if acute pvt is found , patients have to be treated with anticoagulant therapy .
a 56-year - old male was admitted with symptoms of belching , abdominal pain and weight loss of 2 weeks duration . 
 examination revealed hepatosplenomegaly which was confirmed by computed tomography ( ct ) . 
 ct images also revealed filling defects in the portal vein and intrahepatic branches consistent with thrombosis and hepatosplenic infarcts . 
 alkaline phosphatase was elevated at 688 units , all other investigations , including full blood count , coagulation screen and tumour markers , were normal . 
 magnetic resonance cholangiopancreatography did not reveal any mass in the porta hepatis . 
 upper gastrointestinal endoscopy and colonoscopy were normal . 
 liver biopsy was normal and did not reveal any evidence of lymphoma . 
 the raised alkaline phosphatase settled to reference range over a period of 3 weeks . 
 thrombophilia screen was negative . 
 contrast ct of the abdomen performed after 4 weeks displayed revascularisation of the previously thrombosed portal vein and intrahepatic branches . 
 the patient has remained asymptomatic since and we note spontaneous recanalisation of the previously occluded portal vein .