Edemoascitis decompensation. Is it always liver cirrhosis?

Abstract

Portal hypertension (PH) is a clinical syndrome characterized by an increase in the portal hepatic venous pressure gradient (HVPG), defined as the gradient between the portal vein and the inferior vena cava. When there is clinically significant PH, it is usually associated with clinical events such as the development of esophagogastric varices (EGV), oedemoascitic decompensation, encephalopathy... these being more frequent in the case of PH due to liver cirrhosis.

In all etiologies of PH there is an increase in resistance to portal blood flow, followed by an increase in said flow. Depending on the location of the increased resistance, it will be classified as prehepatic, intrahepatic or posthepatic PH[1]. Posthepatic portal hypertension occurs when there is a deterioration in hepatic venous outflow, increasing resistance at this level.

We present the case of a patient where a striking portal dilation led to the diagnosis of posthepatic PH.

Keywords: posthepatic portal hypertension, ascites, membranous occlusion of the inferior vena cava.