Portal vein tumor thrombus from gastric cancer

• Main Authors: Sidney Ching Liang Ong, Santha Kumari Batumaly, Suryani Md Jusoh
• Format: Article
• Language: English
• Published: Medical Communications Sp. z o.o. 2018-12-01
• Series: Journal of Ultrasonography
• Subjects: stomach neoplasms; portal vein; thrombosis; ultrasonography
• Online Access: http://jultrason.pl/index.php/issues/volume-18-no-75/portal-vein-tumor-thrombus-from-gastric-cancer?aid=686

A 53-year-old woman presented with left-sided abdominal pain, nausea and vomiting for the past 3 months with associated loss of appetite and weight. On physical examination, there was a large, ill-defined, firm mass at the epigastrium. Ultrasonography showed heterogeneously hypoechoic filling defect within the dilated main portal vein. The filling defect showed florid signals on Doppler mode and it appeared to be an extension of a larger periportal mass. Contrast enhanced abdominal computed tomography confirmed a large distal gastric mass infiltrating into the periportal structures, including the main portal vein and the splenic vein. Esophagogastroduodenoscopy performed 2 days later showed an irregular, exophytic mass extending from the antrum into the first part of duodenum. The mass was deemed inoperable. Histopathological examination showed gastric adenocarcinoma. She was started on anticoagulant, chemotherapy and pain management. Follow-up computed tomography 4 months later showed liver metastases and formation of collateral blood vessels.