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ec tr o n ic re p ri n t fo r p er so n al u se Endoscopic ultrasound-guided fine needle aspiration of splenic vein thrombosis: a novel approach to the portal venous system A diagnosis of portal system thrombosis can be easily obtained with conventional digital imaging [1]; however, the etiology of the thrombosis can be difficult to assess in the absence of the characteristic hallmarks of a malignant or benign thrombus. When a definitive diagnosis is required, transabdominal ultrasound-guided fine needle aspiration (FNA) of the portal vein thrombus can be performed [2], but this technique is not widely used because of the risk of post-biopsy bleeding complications. We report the case of a 29-year-old man with a history of hepatocellular carcinoma (HCC), for which he had undergone a major hepatic resection when still a child. After a 20-year recurrence-free interval, a left lobe hepatectomy was performed because of HCC recurrence. The right lobe was treated 9 months later with multiple transarterial chemoembolizations because of multifocal recurrence. When, 6 months later, a major radiological and alpha-fetoprotein tumor response was observed, the patient underwent liver transplantation. One year after the transplant, a splenic vein thrombosis was detected on a computed tomography (CT) scan (●" Fig.1). An endoscopic ultrasound (EUS)-guided approachwas considered themost appropriate to obtain a diagnosis as to the nature of the thrombus. An EUS-guided FNA was performed using a transgastric approach (●" Fig.2), with a 25-gauge needle (Wilson-Cook Medical, Winston-Salem, North Carolina, USA), without any immediate or delayed complications (●" Video 1).