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Portal vein thrombosis (PVT) is a rare condition whose exact prevalence is unknown. In developing countries like India it is most often due to umbilical or intra-abodominal sepsis in young patients. In South-East Asia, PVT is usually seen in middle age and above commonly when due to hepatitis-B related chronic liver disease or HCC, and other malignancies, being extremely rare in those below 30 years. We report a case of abrupt onset PVT with incidentally detected hepatitis-B associated cirrhosis of liver and HCC in a previously healthy young man, presenting with acute hepatic decompensation and some unusual features in the involvement of the portal vein.