CASE REPORT

A 44-year-old woman presented with abdominal pain, clinical findings 

of peritonism, and raised inflammatory markers. The patient was 

referred for CT scanning. The diagnosis of superior mesenteric vein 

(SMV) thrombosis was made with the aid of multidetector CT, after 

intravenous contrast, with reconstruction in the sagittal and coronal 

planes (Figs 1 and 2).

Clinical presentation of SMV thrombosis may be quite variable. 

Although it may mimic acute mesenteric arterial ischaemia, presentation 

is often less menacing with nonspecific and non-localising symptoms 

and signs dominating the picture.1 The most common symptoms are 

abdominal pain (nonspecific), anorexia and diarrhoea.2 Studies have 

reported that most patients are symptomatic for a period of more than 

48 hours at the time of diagnosis.1, 2  

Predisposing factors include recent abdominal surgery, infection/

inflammation (appendicitis, pancreatitis), and hypercoagulation.1 CT 

has been found to be effective in the diagnosis of SMV thrombosis,2-4 

with CT findings of mesenteric congestion and bowel wall thickening 

associated with ischaemia.1  

1. Warshauer DM, Lee JKT, Mauro MA, White GC 2nd. Superior mesenteric vein thrombosis with 

radiologically occult cause: a retrospective study of 43 cases. Am J Roentgenol 2001; 177:837-841.

2. Rhee RY, Gloviczki P, Mendonca CT, et al. Mesenteric venous thrombosis: still a lethal disease in the 

1990s. J Vasc Surg 1994; 20:688-697.

3. Schmutz GR, Benko A, Billiard JS, Fournier L, Peron JM, Fisch-Ponsot C. Computed tomography of 

superior mesenteric vein thrombosis following appendicectomy. Abdom Imaging 1998; 23:563-567.

4. Franquet T, Bescos JM, Reparaz B. Noninvasive methods in the diagnosis of isolated superior mesenteric 

vein thrombosis: US and CT. Gastrointest Radiol 1989; 14:321-325.

Superior mesenteric vein thrombosis

A Brandt, MB ChB
B Louw, MB ChB

G Dekker, MB ChB
S Hlongwane, MB ChB

  M Pienaar, MB ChB 

Department of Radiology, Tygerberg Hospital and University of Stellenbosch

PICTORIAL INTERLUDE

26         SA JOURNAL OF RADIOLOGY • June 2006

Fig. 2. The porto-venous phase of a contrast-enhanced reconstructed 
coronal CT study. The SMV thrombosis is extending up to the conflu-
ence with the splenic vein. The top arrow indicates the thrombosis. Note 
the mesenteric congestion (middle arrow) and the dilated bowel (bottom 
arrow). 

Fig. 1. The porto-venous phase of a contrast-enhanced reconstructed 
sagittal CT study. The SMV thrombosis is labelled with an arrow and is 
seen as an area of decreased enhancement in the SMV.

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