Shear Wave Elastography in Children with Portal Vein Thrombosis is not a Sensitive Predictor of Upper Gastrointestinal Bleeding: a Pilot Study

: Background: Extrahepatic portal vein thrombosis (EHPVT) is a cause of portal hypertension in children. It is complicated by upper gastrointestinal variceal bleeding. Aim of the work: to study shear wave elastography (SWE) assessed liver and spleen stiffness among children with EHPVT as a predictor of esophageal varices, its grade and/or upper gastrointestinal (GIT) bleeding. Methods: This case-control study included 18 children with EHPVT who were not secondary to liver disease and 18 healthy children as a control group who underwent ultrasonography and SWE of the liver and spleen. The patient group underwent upper GIT endoscopy as well. Results: The mean ± SD age of the children with EPVT was 9.11 ± 5.26 years, and 5 (27.7%) were females. Three (16.7%) had thrombophilia, 11 (61.1%) had undergone neonatal placement of umbilical catheter, both neonatal intensive care unit admission and thrombophilia in 2 (11.1%) and omphalitis in one (5.5%). All had clinically evident splenomegaly and sonographic evidence of portal vein cavernoma, 2 had recanalized portal vein. SWE stiffness of the right lobe was 7.39 ± 0.86 kPa, the left lobe was 7.64± 0.99 kPa and splenic stiffness was (mean± SD was 68.1 ± 22.8 kPa and range 28-121 kPa) among those with EHPVT, compared to the control group which was 6.83 ± 0.37 kPa, 7.39 ± 0.85 kPa, and (mean± SD was 19.61 ± 2.7 kPa and range 17.2-24.2 kPa), (p = 0.018), (p=0.036) and (p=0.00001) respectively. Esophageal varices bleeding and grade did not correlate with the modified caudate to right lobe diameter ratio (p=0.621), and (p= 0.53), stiffness of the right lobe (p=0.64) and (p= 0.684), left lobe (p=0.297) and (p= 0.223), or spleen stiffness (p=0.499) and (p= 0.196) respectively. Eleven (61.1%) had patent lienorenal collaterals, they were older (mean age 10± 5.3years) compared to those who did not develop (6.7 ± 3.6 years) lienorenal collaterals (p=0.06).