In 2019, VALDIG proposed the term of porto-sinusoidal vascular liver disease (PSVD) to describe a group of rare vascular liver entities characterized by histological lesions involving portal venules and/or sinusoids and absence of cirrhosis, with or without signs of portal hypertension (1). Recently, the Baveno VII consensus workshop preferred the term “disorder” instead of “disease” so that PSVD now stands for “porto-sinusoidal vascular liver disorder”. PSVD is defined as follows:
- Adequate liver biopsy (≥20 mm long, and not too fragmented, or considered adequate for interpretation by an expert pathologist) or liver explant without cirrhosis AND one sign specific for portal hypertension or one histological lesion specific for PSVD;
- Or adequate liver biopsy (≥20 mm long, and not too fragmented, or considered adequate for interpretation by an expert pathologist) or liver explant without cirrhosis AND one sign not specific for portal hypertension AND one histological lesion not specific for PSVD.
Histology is therefore mandatory for the diagnosis of PSVD, with a high quality liver biopsy, and an interpretation by an expert pathologist. Non-invasive tests appear useful tools to screen for PSVD. Elkrief et al. showed that liver stiffness measurement using transient elastography is able to raise suspicion of PSVD in patients with signs of portal hypertension with high accuracy (2). Ferreira-Silva et al. found that spleen stiffness measurement using transient elastography has a good performance in predicting high-risk varices in patients with non-cirrhotic portal hypertension (3), but this result was not observed by other groups (4).