Gajendran et al. Journal of Medical Case Reports 2011, 5:514 http://www.jmedicalcasereports.com/content/5/1/514 Page 3 of 4 Figure 3 Computed tomography (CT) scan scout view showing right portal vein thrombus and liver abscess. Figure 4 Color Doppler showing no flow in right portal vein. the next four days. She improved clinically and was dis- charged home on ertapenem and enoxaparin. A follow- up CT scan two weeks later showed a new pelvic abscess 7.5 × 6 cm that was drained by a pigtail catheter, but there was no change in the portal venous thrombus. Her hypercoagulable profile was negative. A repeat CT scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus for which enoxa- parin was continued. Conclusions Unlike bland portal vein thrombosis, pylephlebitis is more commonly associated with liver abscesses and bac- teremia [2]. Escherichia coli and Bacteroides fragilis are the most common isolates in blood [3]. Doppler ultra- sound, CT scanning and MRI scanning of the abdomen has improved the ability to diagnose pylephlebitis [4]. CT scanning demonstrates portal vein thrombus as a non-enhancing, low-density thrombus within the vessel lumen with non-homogeneous enhancement of the hepatic parenchyma [5]. MRI can help to distinguish acute from chronic portal vein thrombosis [6]. Manage- ment of pylephlebitis is best achieved by treating the primary source using broad-spectrum intravenous anti- biotics and surgical intervention (appendectomy or colectomy with abscess drainage) [1,2]. Early diagnosis