Labs

The following is the complete blood count (CBC) at the time of admission:

WBC (109/L)Hb (g/dL)MCV (fL)PLT (109/L)
7.614.395192

What’s what: WBC, white blood cell count; Hb, hemoglobin; MCV, mean cell volume; MCHC, mean cellular hemoglobin concentration; RDW-SD, red cell distribution width-standard deviation; platelets, PLT; Normal values: WBC 5-10 x 109/L, RBC 4-6 x 1012/L, Hb 12-16 g/dL, Hct 35-47%, MCV 80-100 fL, MCHC 32-36 g/dL, RDW-SD < 45 fL, platelets (PLT) 150-450 x 109/L

Other labs showed normal:

  • Prothrombin time (PT)
  • Activated partial thromboplastin time (aPTT)
  • Urea, creatinine and electrolytes
  • AST, ALT, alkaline phosphate and bilirubin

Expected lab tests in portal vein thrombosis:

  • May show elevations in plasma levels of acute phase reactants.
  • Liver tests typically normal because hepatic arterial blood flow compensates for decreased portal inflow, although a transient, moderate increase in serum aminotransferases is seen in some patients.
  • In patients with bowel ischemia, laboratory testing may reveal
    • Metabolic acidosis
    • Signs of renal or respiratory failure
    • Leukocytosis
    • Elevated hematocrit due to hemoconcentration

Which of the following imaging modalities is/are acceptable for diagnosing PVT?

a
Doppler ultrasound
b
Computed tomography
c
Magnetic resonance imaging (MRI)
d
Echocardiogram

The following are the imaging results from the patient:

Abdominal ultrasound:

Computed tomography angiography (CTA):

Guideline recommendations regarding diagnosis of portal vein thrombosis:

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