An afebrile patient with severe abdominal pain shows specific sonographic findings. Which pathology is most consistent in this case?

The presence of severe abdominal pain in an afebrile patient, along with specific sonographic findings, aligns well with portal vein thrombosis. This condition is characterized by the occlusion of the portal vein, leading to a range of complications that can manifest on ultrasound.

On sonography, specific signs such as the absence of venous flow within the portal vein, echogenicity changes in the liver, and the potential development of collateral vessels may be noted. The abrupt interruption of normal blood flow can lead to abdominal pain due to intestinal ischemia and other related causes. In the context of an afebrile patient, where fever often suggests an infectious process or inflammatory conditions, portal vein thrombosis provides a clear pathological explanation for the acute abdomen without an infectious component.

Other conditions like cirrhosis, Caroli's disease, and Budd-Chiari syndrome could also present with abdominal pain and specific ultrasound findings, but they often do not fit as neatly into the scenario described. Cirrhosis typically presents with chronic complications rather than an acute severe abdominal pain in an afebrile state. Caroli's disease involves cystic dilatation of the bile ducts, which usually presents with biliary symptoms or jaundice rather than acute abdominal pain