INTRODUCTION
Cavernous transformation of the portal vein (CTPV) also known as portal
cavernoma is a very rare condition of the liver which is usually
characterized by the formation of multiple tortuous tiny blood vessels
within and around a portal vein which has been partially or completely
occluded by a thrombus 1–3.
Liver cirrhosis, hepatoma, splenectomy, liver transplant and
pancreatitis are known causes of portal vein thrombosis that
subsequently leads to CTPV in adults 1. However, CTPV
have been mostly recorded in individuals with long-term thrombosis of
the portal vein without evidence of primary liver
disease1–3. Cases of CTPV have also been recorded in
individuals with hematological diseases 4 and those
with primary systemic vascular abnormalities which have resulted in
chronic portal vein thrombosis 1,2,5.
The initial diagnosis of CTPV by clinicians may be challenging due to
its diverse causes and clinical presentations 4,6.
Common clinical manifestations are however those associated with portal
hypertension as a result of chronic portal vein thrombosis; such as
upper gastrointestinal bleeding (secondary to esophageal varices),
anemia, splenomegaly, and ascites 3.
Abdominal Duplex Ultrasonography is a useful first-line imaging tool for
both adult and pediatric patients with clinical presentations pointing
towards the suspicion of liver disease or portal hypertension; because
it allows for examination of abdominal organs and their vascular
architecture in a real-time, efficient and safe
manner7. Computed Tomography Angiography (CTA) and
Magnetic Resonance Angiography (MRA) may be used for the confirmation of
CTPV when an initial diagnosis is made with ultrasonography.
We therefore report on a case of a 22-year-old male in whom a diagnosis
of cavernous transformation of the portal vein was made with Duplex
ultrasonography who presented clinically with anemia and hematemesis.