Background: Portal vein thrombosis (PVT) can be a difficult clinicalproblem to assess and manage. A high index of suspicion is needed for aPVT diagnosis given the subtle presentation and potentially serious longtermcomplications.Subjects and methods: We studied 30 patients who presented with thefirst attack of hematemesis and /or melena, at the Tropical andHepatology Institute ministry of health. The population of the study weresubjected to thorough history taking, proper clinical examination and tolaboratory, endoscopic and ultrasound examination [grey and colorcoded].It included subjects from both sexes and age group ranging from40 to 70 years.Results: The study showed that the incidence of portal vein thrombosis inthe patients presenting with first attack of hematemesis is 20% withhighly significant correlation between portal vein thrombosis and thepresence of hepatic focal lesions and elevation of the serum AFP in thosepatients.Conclusion: Our study results indicated that portal vein thrombosis is notuncommon in cirrhotic patients presenting with the first attack of varicealbleeding and this emphasizes the importance of using ultrasonographywith color-coded Doppler with all patients to assess for this complication.Also, our study showed that the presence of portal vein thrombosis shouldattract the attention of the sonographer to look carefully for focal hepaticlesions as HCC commonly invade the portal vein or its branches.