Portosinusoidal vascular liver disorder (PSVD) is an uncommon cause of clinically significant portal hypertension that can be misdiagnosed as cirrhosis, leading to delayed management. We report a case in which low liver stiffness, portal hypertension manifestations, and hemodynamic assessment reoriented the diagnosis. A 61-year-old man previously diagnosed with MetALD and prior oxaliplatin-based chemotherapy presented in 2017 with variceal upper gastrointestinal bleeding. Although imaging suggested cirrhosis with portal vein thrombosis, liver stiffness was low (LSM 7.7 kPa) and HVPG was 9 mmHg. Inconsistencies in the diagnostic work up led us to perform a liver biopsy, which showed portal abnormalities with focal sinusoidal dilatation and no fibrosis. Even when other potential causes of liver disease are present, in the absence of a liver biopsy, the underlying aetiology cannot be assumed to be the driver of portal hypertension; in this setting, liver elastography together with invasive hepatic hemodynamic measurements can help reorient the diagnosis toward PSVD and guide management.
Morales et al. (Sat,) studied this question.