Fig. 2.Ultrasound showed portal vein thrombus and dilatation to 21 mm.

A 22-year-old African-American male presented to an outside hospital two years previously complaining of malaise, fatigue, weight loss, abdominal pain, arthralgias, headache, and intermittent fevers. His past medical history was significant for uveitis and meningitis. On the basis of this history he was diagnosed as having Behcet's disease.

After two years of waxing and waning symptoms, an arteriogram at another hospital showed "diffuse central arterial stenoses of the SMA branches only visualized when priscoline was administered", suggesting vasculitis (Figure 1). No contrast was identified in the portal vein suggesting portal vein thrombosis. Ultrasound showed portal vein thrombus extending into the splenic vein. The portal vein was dilated to 21 mm (Figure 2). There was cavernous transformation. Ultrasound at another hospital a month earlier had reportedly shown a patent portal vein. Abdominal CT showed portal vein thrombosis and marked distension suggesting infectious thrombophlebitis or neoplastic thrombus. There were multiple low attenuation areas consistent with abscesses (Figure 3). There was an elevated sedimentation rate of 130 and a WBC count of 25,000. Ultrasound guided fine-needle aspiration of the portal vein revealed pus, which grew E. coli. The patient was referred for possible thrombolysis of the portal venous thrombosis.