In Reply to: Re: Case 0100_06 -- Management of Acute Liver Failure in a Patient with Portal and Hepatic Vein Thrombosis posted by Michael Pfister on January 05, 19100 at 23:08:51:
Our thinking was that the acute exacerbation was due to acute hepatic vein thrombosis and not portal vein thrombosis. Hepatic vein thrombosis (Budd Chiari) especially if acute, is a malignant event often with catastrophic consequences (especially if associated with acute systemic hypercoagulable states like PNH, SLE etc.). I have never seen portal thrombosis, in the setting of chronic portal hypertenison, to cause acute liver failure. Most of these patients shunt a lot of their portal blood spontaneously anyways. The TIPS in this case was performed to deal primarily with the hepatic vein problem. We obviously wanted to clear the portal clot and that may have been a mistake since it lead to his demise. What I find interesting about this case is the presence of both portal and hepatic vein clot, something that is not seen often and is likely to have a very malignant course.