An Elusive Diagnosis in Noncirrhotic Chronic Portal Vein Thrombosis

A 66-year-old man with a history of hypertension, dyslipidemia, and pulmonary tuberculosis in adolescence presented to our clinic with melena and 2-point loss of hemoglobin. Additional laboratory values revealed thrombopenia (102,000/μL) and values within the normal range of liver blood tests. Urgent esophagogastroduodenoscopy evidenced active bleeding from esophageal varices that were treated endoscopically with band ligation and medically with somatostatin and ceftriaxone. An extended liver etiology screen was negative, and an abdominal computed tomography scan additionally revealed calcified lymph nodes in relation to previous tuberculosis, absence of visible portal lumen in the portal phase, and abundant collaterals at the hepatic hilum (Figure, A).