Interventional Management of Suppurative Pylephlebitis with Portal Vein Abscess Masquerading as Bland Portal Vein Thrombosis in Severe Acute Necrotizing Pancreatitis: A Case Report

Suppurative pylephlebitis—infected portal vein thrombosis (PVT) secondary to necrotizing pancreatitis—is rare and fatal, often mimicking bland PVT in unresolving sepsis. Diagnosis challenges persist due to low incidence, but suspicion arises in critically ill patients with uniform portal venous thrombus unresponsive to antibiotics. We describe the imaging findings and interventional management of a patient who presented with persistent unexplained fever and was subsequently diagnosed with portal vein pyemia. Percutaneous ultrasound and fluoroscopy-guided aspiration and drainage led to the evacuation of purulent material from the portal vein, resulting in rapid clinical and biochemical recovery. This report emphasizes the critical diagnostic and therapeutic role of interventional radiology in the management of suppurative PVT.