Portal vein thrombosis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Portal vein thrombosis}}
{{Portal vein thrombosis}}
{{CMG}} {{AE}}
{{CMG}} {{AE}}{{F.K}} [mailto:fkahe@bidmc.harvard.edu] [mailto:fkahe@bidmc.harvard.edu] [mailto:fkahe@bidmc.harvard.edu] [mailto:fkahe@bidmc.harvard.edu]


== Overview ==
== Overview ==
* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
[[Ultrasonography]] is the gold standard test for the diagnosis of portal vein thrombosis. The following result of [[ultrasonography]] include: Portal cavernoma (multiple tortuous small vessels replacing the portal vein) and absence or reduced flow in [[portal vein]] is confirmatory of portal vein thrombosis.
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].  
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
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* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
===== Template statements =====


=== Gold standard/Study of choice: ===
=== Gold standard/Study of choice: ===
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* [[Ultrasonography]] is the gold standard test for the diagnosis of [[portal vein]] thrombosis.<ref name="pmid25941431">{{cite journal |vauthors=Chawla YK, Bodh V |title=Portal vein thrombosis |journal=J Clin Exp Hepatol |volume=5 |issue=1 |pages=22–40 |year=2015 |pmid=25941431 |pmc=4415192 |doi=10.1016/j.jceh.2014.12.008 |url=}}</ref>
* The following result of [gold standard test] is confirmatory of [disease name]:
* Among patients who present with clinical signs of absence or reduced flow in [[portal vein]], the contrast enhanced ultrasound (CEUS) is the most specific test for the diagnosis.
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison table for diagnostic studies of choice for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
The [[ultrasonography]] is confirmatory of [[portal vein]] thrombosis:
* Result 1
* Portal cavernoma (multiple tortuous small vessels replacing the portal vein)
* Result 2
* Absence or reduced flow in [[portal vein]]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
*Benign portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:<ref name="PiscagliaGianstefani2010">{{cite journal|last1=Piscaglia|first1=Fabio|last2=Gianstefani|first2=Alice|last3=Ravaioli|first3=Matteo|last4=Golfieri|first4=Rita|last5=Cappelli|first5=Alberta|last6=Giampalma|first6=Emanuela|last7=Sagrini|first7=Elisabetta|last8=Imbriaco|first8=Grazia|last9=Pinna|first9=Antonio Daniele|last10=Bolondi|first10=Luigi|title=Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinom for liver transplantation|journal=Liver Transplantation|year=2010|pages=NA–NA|issn=15276465|doi=10.1002/lt.22044}}</ref><ref name="pmid19032223">{{cite journal |vauthors=Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D'Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD |title=Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria |journal=Am. J. Transplant. |volume=8 |issue=12 |pages=2547–57 |year=2008 |pmid=19032223 |doi=10.1111/j.1600-6143.2008.02409.x |url=}}</ref>  
*Benign [[portal vein]] thrombosis may be diagnosed at any time if one or more of the following criteria are met:<ref name="PiscagliaGianstefani2010">{{cite journal|last1=Piscaglia|first1=Fabio|last2=Gianstefani|first2=Alice|last3=Ravaioli|first3=Matteo|last4=Golfieri|first4=Rita|last5=Cappelli|first5=Alberta|last6=Giampalma|first6=Emanuela|last7=Sagrini|first7=Elisabetta|last8=Imbriaco|first8=Grazia|last9=Pinna|first9=Antonio Daniele|last10=Bolondi|first10=Luigi|title=Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinom for liver transplantation|journal=Liver Transplantation|year=2010|pages=NA–NA|issn=15276465|doi=10.1002/lt.22044}}</ref><ref name="pmid19032223">{{cite journal |vauthors=Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D'Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD |title=Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria |journal=Am. J. Transplant. |volume=8 |issue=12 |pages=2547–57 |year=2008 |pmid=19032223 |doi=10.1111/j.1600-6143.2008.02409.x |url=}}</ref>  
**Lack of vascularization of the thrombus on contrast-enhanced ultrasound(CEUS)
**Lack of vascularization of the thrombus on contrast-enhanced ultrasound (CEUS)
**Absence of mass-forming features of the thrombus on CT or MRI
**Absence of mass-forming features of the [[thrombus]] on [[CT]] or [[MRI]]
**Absence of disruption of the walls of veins on CT or MRI
**Absence of disruption of the walls of veins on [[CT]] or [[MRI]]
**Absence of evidence of disruption of vessel walls
**Absence of evidence of disruption of vessel walls
**No features of malignancy in a biopsy sample of the thrombus
**No features of malignancy in a biopsy sample of the [[thrombus]]
**Stability or regression of the thrombus during follow-up
**Stability or regression of the thrombus during follow-up
*Malignant portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:<ref name="OsmanSamy2016">{{cite journal|last1=Osman|first1=Nasr Mohamed Mohamed|last2=Samy|first2=Laila Adel Mohamed|title=Benign and malignant portal venous thrombosis: Multi-modality imaging evaluation|journal=The Egyptian Journal of Radiology and Nuclear Medicine|volume=47|issue=2|year=2016|pages=387–397|issn=0378603X|doi=10.1016/j.ejrnm.2016.02.010}}</ref>
**Expansion of the involved vessel (vessel diameter > 1.8 cm) for the main [[portal vein]]
**Tumor size >5 cm and distance <2 cm


==References==
==References==
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
{{reflist|2}}
* For information on how to add references into your page, click [[Adding References to Articles|here]].

Latest revision as of 14:33, 29 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2] [3] [4] [5] [6]

Overview

Ultrasonography is the gold standard test for the diagnosis of portal vein thrombosis. The following result of ultrasonography include: Portal cavernoma (multiple tortuous small vessels replacing the portal vein) and absence or reduced flow in portal vein is confirmatory of portal vein thrombosis.

Diagnostic Study of Choice

Gold standard/Study of choice:

  • Ultrasonography is the gold standard test for the diagnosis of portal vein thrombosis.[1]
  • Among patients who present with clinical signs of absence or reduced flow in portal vein, the contrast enhanced ultrasound (CEUS) is the most specific test for the diagnosis.
Diagnostic results

The ultrasonography is confirmatory of portal vein thrombosis:

  • Portal cavernoma (multiple tortuous small vessels replacing the portal vein)
  • Absence or reduced flow in portal vein

Diagnostic Criteria

  • Benign portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:[2][3]
    • Lack of vascularization of the thrombus on contrast-enhanced ultrasound (CEUS)
    • Absence of mass-forming features of the thrombus on CT or MRI
    • Absence of disruption of the walls of veins on CT or MRI
    • Absence of evidence of disruption of vessel walls
    • No features of malignancy in a biopsy sample of the thrombus
    • Stability or regression of the thrombus during follow-up
  • Malignant portal vein thrombosis may be diagnosed at any time if one or more of the following criteria are met:[4]
    • Expansion of the involved vessel (vessel diameter > 1.8 cm) for the main portal vein
    • Tumor size >5 cm and distance <2 cm

References

  1. ↑ Chawla YK, Bodh V (2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
  2. ↑ Piscaglia, Fabio; Gianstefani, Alice; Ravaioli, Matteo; Golfieri, Rita; Cappelli, Alberta; Giampalma, Emanuela; Sagrini, Elisabetta; Imbriaco, Grazia; Pinna, Antonio Daniele; Bolondi, Luigi (2010). "Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinom for liver transplantation". Liver Transplantation: NA–NA. doi:10.1002/lt.22044. ISSN 1527-6465.
  3. ↑ Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D'Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD (2008). "Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria". Am. J. Transplant. 8 (12): 2547–57. doi:10.1111/j.1600-6143.2008.02409.x. PMID 19032223.
  4. ↑ Osman, Nasr Mohamed Mohamed; Samy, Laila Adel Mohamed (2016). "Benign and malignant portal venous thrombosis: Multi-modality imaging evaluation". The Egyptian Journal of Radiology and Nuclear Medicine. 47 (2): 387–397. doi:10.1016/j.ejrnm.2016.02.010. ISSN 0378-603X.
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