22nd May 2025

A 68-year-old woman presents with haematemesis and melaena.

A 68-year-old woman presents with haematemesis and melaena. She has no features of chronic liver disease and physical examination demonstrates splenomegaly only. Blood tests show bilirubin, ALT and ALP within normal limits. An endoscopy confirms a single bleeding oesophageal varix which undergoes successful band ligation. On further questioning, the patient reports being under the haematology team for a diagnosis of myeloma.

Which of the following is the most likely to confirm the cause of this patient’s portal hypertension?

Select the SINGLE most appropriate option from the list below. Select ONE option only.