Portal system thrombosis after splenectomy for neoplasm or chronic hematologic disorder: is routine surveillance imaging necessary?

PURPOSE

This study was undertaken to assess the frequency and sequelae of portal system thrombosis (PST) after splenectomy in patients with cancer or chronic hematologic disorders and to determine whether routine surveillance imaging for this potential complication is warranted.

METHOD

The radiology reports of 203 consecutive patients with cancer or chronic hematologic disorders who underwent splenectomy between January 1990 and January 1997 were reviewed. Imaging examinations and medical records were reviewed for those in whom PST was found after splenectomy.

RESULTS

One hundred twenty-three patients (60.6%) underwent CT (n = 88), sonography (n = 10), or both (n = 24) after splenectomy; one other patient underwent MRI. Twelve of these patients (9.8%) had thrombosis of the splenic, portal, and/or superior mesenteric veins. Their underlying diseases were myelofibrosis/ myelodysplastic syndrome (n = 8), lymphoma (n = 3), and leukemia (n = 1). At follow-up imaging (obtained in 10 of the 12 patients), PST had resolved (n = 5), worsened (n = 2), improved (n = 1), remained unchanged (n = 1), or resulted in cavernous transformation of the portal vein (n = 1). Nine of 12 patients were symptomatic. No patient died of PST.

CONCLUSION

PST was an uncommon and typically unsuspected finding after splenectomy in this patient population, and no serious sequelae of PST were found. Routine surveillance imaging for PST after splenectomy does not seem warranted, but in symptomatic patients (particularly those with myelofibrosis/myelodysplastic syndrome), a high clinical suspicion and a low threshold for obtaining imaging examinations are needed.