Farrukh Saeed, Tassawar Hussain, Raheel Iftikhar.
An unusual presentation of Essential Thrombocytosis.
Pak Armed Forces Med J Jan ;57(3):226-9.

The patient was 39 years old male presented with 01 day history of severe epigastric pain and vomiting. On examination he was distressed, restless and sweating profusely. His vital signs revealed pulse of 105/minute and respiratory rate of 25/minute. Examination of abdomen revealed marked tenderness in epigastric region with splenomegaly. His blood complete picture revealed a platelet count of 550,000/cmm. Upper GI endoscopy revealed severe pangastritis with portal naturopathy. His USG abdomen revealed portal vein thrombosis and splenomegaly. CT scan abdomen revealed a large thrombus obliterating portal vein with splenomegaly. A suspicion of myeloproliferative disorder was made and patient was investigated. His investigations revealed a consistently elevated platelet count >600,000/µL. Doppler scan revealed completely thrombosed portal vein, varicosed splenic vein and formation of periportal collaterals thus indicating chronic portal vein thrombosis. The patient was thus diagnosed as a case of essential thrombocytosis and according to risk stratification, was considered a high risk patient for complications.

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