Ultrasound and Computed Tomography Features of Non Cirrhotic Portal Hypertension caused due to Non Cirrhotic Portal Fibrosis and Extrahepatic Portal Vein Obstruction: A Retrospective Study

Abstract

Introduction: Non Cirrhotic Portal Hypertension (NCPH) encompasses a wide range of disorders that are characterised by increased portal pressure with the absence of cirrhosis of liver. The disorders are classified anatomically based on the site of blood flow obstruction into prehepatic, hepatic and posthepatic causes. These numerous and variable aetiological factors and the lack of standardised diagnostic criteria, makes NCPH under-recognised both clinically and pathologically and often being falsely labelled as cryptogenic cirrhosis. Therefore, it is important for radiologists to be aware of the imaging features that constitute NCPH for its early recognition, so that appropriate management can be carried out. Aim: To assess the distinct ultrasound and Computed Tomography (CT) features of the two main causes of NCPH: Non Cirrhotic Portal Fibrosis (NCPF) and Extrahepatic Portal Venous Obstruction (EHPVO). Materials and Methods: This retrospective observational study included all radiologically diagnosed cases of NCPH who underwent ultrasound and CT examination at the Institution between June 2020-June 2021. A total of 10 patients met the inclusion criteria. The various imaging features of NCPF and EHPVO were analysed and tabulated. Results: The study showed male predominance with males and females being seven and three, respectively. The mean age of the patients in the study was 35.1 years. The common cause in both NCPF and EHPVO was idiopathic. The most characteristic imaging finding in EHPVO was cavernous transformation of the portal vein seen in all cases and that in NCPF being dilatation of the spleno-portal axis and mural thickening of the main portal vein seen in all the cases. Conclusion: The present study demonstrated the characteristic imaging features of NCPF and EHPVO which are leading cause of NCPH, facilitating radiologist to identify the conditions and not label cases with Portal Hypertension (PHT) as cryptogenic cirrhosis.