Portal Venous and Mesenteric Wall Calcifications along with Intra-splenic Vascular Calcification: A Rare Case Report and Literature Review

Background: Cross-sectional imaging findings of portal vein calcification were found to be an indicator of portal vein thrombosis. Calcification of the portal vein and its tributaries in portal hypertension is an uncommon finding and the mechanical stress due to long-standing portal hypertension on the vessel wall is considered leading to sclerosis and calcification in the intima and media of the vessel wall. Intra-splenic vascular calcification is a rare occurrence and has been seen in patients with portal hypertension. Case Presentation: A 60-year-old male was referred for an ultrasound scan of the abdomen, as he was found to have mild elevation of liver enzymes during a routine medical investigation. His ultrasound scan showed features of cirrhosis and portal hypertension. Furthermore, there were intra-splenic calcifications with branching pattern. Subsequent CT confirmed intra-splenic vascular calcification and calcifications in the wall of the thrombosed portal vein and its tributaries. Conclusion: Pre-operative identification of portal venous calcification is important, as this might adversely affect surgical interventions for cirrhosis and portal hypertension. Furthermore, to our best knowledge, there have not been any cases reported with concurrent calcification of the portal venous system and intra-splenic vascular calcification in association with portal hypertension in literature.