case_images: PMC10682651_01
case_images: Hepatic portal vein CT angiography and digital subtraction-angiography (DSA). (A) Showing portal vein thrombosis (red arrow). (B) Showing superior mesenteric vein thrombosis (red arrow). (C) DSA showed filling defects in the portal and superior mesenteric veins. (D) Visualization of stent shadow after TIPS.
case_images: fcvm-10-1277676-g001.jpg
case_images: PMC10682651_01_fcvm-10-1277676-g001.jpg
case_images: F1
case_images: Abdominal vascular enhanced CT results showed thrombosis of the central portal vein, the left and right branches of the portal vein, and the superior mesenteric vein (Figures 1A,B), and portal hypertension with collateral circulation formation. Portal hypertension and rupture and bleeding of esophageal and gastric varices were considered, and the patient received variceal embolization and TIPS (Figures 1C,D).
case_images: Upper gastrointestinal endoscopy. (A) Scattered erosive focus in the lower esophagus, with a small amount of oozing blood and visible venous exposure. (B) A large ulcer in the lower esophagus near the pyloric ostium.
case_images: fcvm-10-1277676-g002.jpg
case_images: PMC10682651_01_fcvm-10-1277676-g002.jpg
case_images: F2
case_images: Gastroscopy showed erosion, bleeding, and varices in the lower esophagus (Figures 2A,B).
case_images: Species conservation analysis using DNAMAN (Lynnon Biosoft, Quebec, Canada) software showed that the mutation sites of PROS1 gene p.Leu584Arg were homo sapiens, Macaca mulatta, Bos Taurus, Mus musculus, and Species such as rattus norvegicus are highly conservative in evolution.
case_images: fcvm-10-1277676-g003.jpg
case_images: PMC10682651_01_fcvm-10-1277676-g003.jpg
case_images: F3
case_images: CT showed a large heterogeneous density mass in the anterior part of the spleen, with a more significant level of about 6.0 cm x 5.5 cm, mildly heterogeneous enhancement on enhanced scan; patchy iso-slightly high-density shadows in the left paracolic sulcus, with possible hematoma (Figure 3). Considering splenic rupture and hemorrhagic shock, the general surgeon performed a splenectomy immediately, during which the small intestine about 80cm from the ligament of Treitz was resected (local scarring and contracture of the mesenteric and intestinal cavity were observed during the operation, resulting in complete obstruction of the upper intestinal cavity, and some small intestine necrosis). The species conservation analysis of the human PROS1 gene p.Leu584Arg locus showed that it was highly conserved in the evolution of different species (Figure 3).