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1. Introduction {#sec1} =============== Splenic vein thrombosis (SVT) is known as one of the rare causes of upper gastrointestinal bleeding and is mostly seen in the fifth decade of life and male sex \[[@B1], [@B2]\]. So far, 37 different etiologies have been reported for SVT \[[@B3]\]. The typical manifestations are bleeding from gastric varices characterized by anemia, hematemesis, melena, or hematochezia seen in 15%--50% of patients. Splenomegaly is observed in all patients with SVT whether it be in physical examination or imaging evaluation or during surgery \[[@B3]\]. Sometimes other symptoms of splenomegaly such as thrombocytopenia or pancytopenia and abdominal pain are also manifestations of the disease \[[@B4]\]. It must be noted that since liver cirrhosis is absent in SVT, these patients do not have chronic liver disease \[[@B4]\]. Being asymptomatic, in most cases, makes the diagnosis of SVT difficult. However reports of SVT have increased in recent years which could be due to advancement in imaging techniques \[[@B5]\]. Previously, though, most cases of SVT were distinguished in postmortem autopsy but now with the developments such as celiac angiography and splenoportography most cases are readily detectable. Since abdominal CT is used for patients with acute pancreatitis as well as preoperative patients of chronic pancreatitis, SVT is often an incidental finding in the computerized tomography (CT) scan \[[@B5]\]. The diagnosis test of choice for the assessment of SVT is venous-phase celiac angiography \[[@B5]\]. This condition results in increased localized sinistral portal pressure, which is also known as sinistral portal hypertension. The majority of patients with SVT and the resulting sinistral portal hypertension, in contrast to patients with generalized portal hypertension, are asymptomatic and have normal hepatic function. Gastrointestinal bleeding secondary to esophageal or gastric varices may occur in these patients ([Figure 1](#fig1){ref-type="fig"}). Most patients with SVT have peripheral arteries other than gastric varices which never go bleeding. As a result asymptomatic patients without gastric varices should be monitored and do not need treatment for SVT \[[@B4]\]. In other words SVT alone does not need treatment. In symptomatic patients splenectomy is the treatment of choice done by shunting collateral flow \[[@B4]\]. 2. Case Report {#sec2} ============== Patient was an 8-year-old boy referred to our center with massive upper gastrointestinal bleeding. The patient was found to have splenomegaly. He went through multiple evaluations including endoscopy and underwent band ligation for progressive esophageal varices. The patient had no history of neonatal blood exchange and umbilical venous catheters during infancy. No finding suggestive of portal venous thrombosis was observed in Doppler sonography. All the experiments indicated normal hepatic function. Due to recurrent bleeding and signs of hypersplenism and bicytopenia (thrombocytopenia and anemia), CT scan in venography phase was performed, which presented suspicious findings in splenic vein. Patient\'s CT angiography of the abdomen revealed splenomegaly ([Figure 2](#fig2){ref-type="fig"}), dilation and tortuosity of spleen hilum veins and veins lining the esophagus and stomach ([Figure 3](#fig3){ref-type="fig"}), and dilation of coronary and left renal veins ([Figure 4](#fig4){ref-type="fig"}). Haziness was observed throughout the mesenteric fat of the spleen hilum and splenic vein