Mesenteric Venous Thrombosis Workup

  • Author: Deron J Tessier, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 6, 2012
 

Laboratory Studies

  • Unfortunately, laboratory studies are not much help in confirming the diagnosis of venous thrombosis. Laboratory studies help more to suggest, rather than exclude, the diagnosis.
    • Obligatory studies include PT, aPTT, CBC (which may reveal leukocytosis and/or hemoconcentration), and chemistries (which may show metabolic acidosis).
    • Evaluate patients for protein C and S deficiencies; antithrombin III deficiency; and abnormalities in lupus anticoagulant, anticardiolipin antibody, and platelet aggregation.
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Imaging Studies

  • Plain radiographs may show nonspecific findings, such as dilated loops of bowel with air-fluid levels. Air in the portal system may also be observed on plain radiographs, although this is rare.
  • CT scanning (see the image below) is the diagnostic test of choice in patients stable enough to undergo the procedure.[2] Computed tomography (CT) scan demonstrating cavernComputed tomography (CT) scan demonstrating cavernous change of the superior mesenteric vein, a consequence of venous thrombosis.
    • CT scans may show an enlarged mesenteric or portal vein with sharp definition of the venous wall and low density within the vein (thrombus).
    • Other findings, such as gas in the wall of the bowel, fat streaking, and thickened bowel wall, have been described.
  • Magnetic resonance imaging (MRI) is also very sensitive, but because of cost and the time required for the examination, it is not as practical as CT scanning.
  • In a few studies, duplex ultrasonography of the visceral system has been found to be as effective as CT scanning.
    • Duplex scans of the mesenteric vessels are beneficial only if used early.
    • Some researchers believe that duplex scans should be used as a first-line diagnostic tool in any patient thought to have this diagnosis.
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Other Tests

  • Perform an ECG to evaluate cardiac status.
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Diagnostic Procedures

  • An arteriogram may show vasospasm, contrast in the bowel lumen, nonvisualized venous system, reflux of contrast into the aorta, and, finally, absent flow to necrotic bowel areas.
  • CT scanning and angiography have proven equally reliable in helping confirm the diagnosis of acute venous occlusion, although some researchers consider CT scanning to be the diagnostic test of choice.
  • CT angiography and gadolinium-enhanced MR angiography enable volumetric acquisitions with the patient holding only a single breath, and they offer excellent diagnostic capabilities for patients with venous thrombosis.
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Contributor Information and Disclosures
Author

Deron J Tessier, MD  Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA

Deron J Tessier, MD is a member of the following medical societies: American College of Surgeons and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Alex Jacocks, MD  Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

Additional Contributors

The editors of eMedicine would like to thank Russell A Williams, MBBS, for his previous contributions to this article.

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Computed tomography (CT) scan demonstrating thrombosis of the superior mesenteric vein.
Computed tomography (CT) scan demonstrating thrombosis of the portal vein.
Computed tomography (CT) scan demonstrating cavernous change of the superior mesenteric vein, a consequence of venous thrombosis.
 
 
 
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