PMC4748192_01
Endoscopic views from initial EGD showing large varices throughout the entire esophagus prior to intraprocedural hemorrhage.
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F1
He was transfused 2 units of packed red blood cells and an esophagogastroduodenoscopy (EGD) showed large esophageal varices throughout the esophagus with stigmata of recent bleeding (red wale signs; Figure 1).
(A) Axial CT with IV contrast showing near complete occlusion of the main portal vein with cavernous transformation (arrow). (B) Coronal CT with IV contrast showing the confluence of the splenic and superior mesenteric veins into the main portal vein (arrow) with only a sliver of contrast passing through (circled).
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F2
Abdominal computed tomography (CT) later noted complete thrombosis of the splenic vein, non-occlusive thrombus of the superior mesenteric vein extending into smaller mesenteric branches, and complete thrombosis of the left portal vein along with incomplete thrombosis of the right portal vein and cavernous transformation (Figure 2).