Obliterative portal venopathy (OPV) is an important cause of non-cirrhotic
portal hypertension, which is often erroneously misdiagnosed as
cryptogenic cirrhosis. It has a worldwide distribution with majority of cases hailing from the Asian subcontinent. However, recently the disease has gained global attention particularly because of its association with human immunodeficiency virus
infection and use of antiretroviral
drug therapy (
didanosine). As the name suggests, the disorder is characterized by
sclerosis and obliteration of the intrahepatic portal vein branches (with attendant periportal
fibrosis) leading to
portal hypertension amid intriguingly little
liver dysfunction. It primarily affects young adults who present with clinically significant
portal hypertension in the form of episodes of variceal bleed; however, contrasting
liver cirrhosis, the liver function and liver structure remain normal or near normal until late in the disease process. Radiological findings during advanced disease are often indistinguishable from
cirrhosis often warranting a liver biopsy. Nevertheless, recent studies have suggested that certain imaging manifestations, if present, can help us to prospectively suggest the possibility of OPV. At imaging, OPV is characterized by a wide range of intrahepatic and/or extrahepatic portal venous abnormalities with attendant changes in liver and splenic volume and stiffness. We shall, through this pictorial review, appraise the literature and illustrate the germane radiological manifestations of OPV that can be seen using different imaging modalities including ultrasonography, CT, MRI, elastography and hepatic haemodynamic studies.