Published online Aug 27, 2019. doi: 10.4254/wjh.v11.i8.613
Peer-review started: March 26, 2019
First decision: June 16, 2019
Revised: July 3, 2019
Accepted: July 16, 2019
Article in press: July 17, 2019
Published online: August 27, 2019
Porto sinusoidal vascular liver disease (PSVD) and portal vein thrombosis (PVT) are distinct vascular liver diseases characterized, respectively, by an intrahepatic and a prehepatic obstacle to the flow in the liver portal system. PVT may also occur as a complication of the natural history of PSVD, especially if a prothrombotic condition coexists. In other cases, it is associated to local and systemic pro-thrombotic conditions, even if its cause remains unknown in up to 25% despite an active search. In our opinion, the presence of PSVD should be suspected in patients with PVT especially in those with PVT “sine causa” and the active search of this condition should be included in their diagnostic work-out. However, sometimes the diagnosis of pre-existing PSVD is very hard. Biopsy cannot be fully discriminant as similar histological data have been described in both conditions. Liver stiffness may help as it has been shown to be higher in PSVD than in “pure” PVT, due to the presence of sclerosis in the portal venous radicles observable in PSVD patients. Nevertheless, comparing liver stiffness between PVT and PSVD has until now been restricted to very limited series of patients. In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors.
Core tip: Porto sinusoidal vascular liver disease (PSVD) and chronic portal vein thrombosis (PVT) are vascular liver diseases. This review aims to discuss the possibility that (PSVD) should be suspected in patients with PVT and to analyse the possible diagnostic tools able to differentiate between these two conditions. Moreover, the review focuses on the possible and relevant clinical consequences of missing a diagnosis of PSVD in patients with PVT.