Doppler Ultrasound Evaluation in Portal Hypertension

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2016

Poster Number:

C-0803

Type:

Educational Exhibit

Keywords:

Haemodynamics / Flow dynamics, Diagnostic procedure, Ultrasound-Spectral Doppler, Ultrasound-Colour Doppler, Veins / Vena cava, Liver, Abdomen

Authors:

N. C. S. D. Ferreira¹, A. L. Amado Costa², �. Marques¹; ¹Lisboa/PT, ²Lisbon/PT

DOI:

10.1594/ecr2016/C-0803

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-0803

Fig. 1: Normal portal vein flow and waveform. Spectral Doppler US shows antegrade or...

Fig. 2: Normal hepatic vein flow and waveform. Spectral Doppler US shows predominantly...

Fig. 3: Normal hepatic artery flow and waveform. Spectral Doppler US shows antegrade...

Fig. 4: Portal Hypertension. Spectral Doppler US shows portal vein with a low velocity...

Learning objectives

The main purpose of this paper is to describe and illustrate the gray scale and Doppler findings in portal hypertension.

Background

HEMODYNAMICS OF THE NORMAL VESSELS OF THE LIVER PORTAL VEIN Physiologic portal venous flow should always beantegradeandhepatopetal(toward the transducer and therefore creates a waveform above the baseline). Flow velocity in this vessel is relatively low (16–40 cm/sec) compared with the hepatic artery. The evaluationof the TAVM (Time average velocities, mean and maximum) will provide a globally more accurate hemodynamic information rather than transient velocities, and should range from 10 to 18 cm/sec on fasting state (Fig.1). Normalphasicitymay range from low to high. Abnormally low phasicity...

Findings and procedure details

PORTAL HYPERTENSION PORTAL VEIN: A portal vein diameter greater than 13 mm is a possible finding in portal hypertension. However, as a diagnostic indicator,it has a sensitivity of 40% or less. Several physiologic factors including a postprandial increment in splanchnic flow, respiratory phasic change and gravity together with patient positional change may cause size variation in the portal vein and, therefore, make this measurement diagnostically unreliable. Abnormallyslow portal venous flowis diagnostic for portal hypertension when peak velocity is less than 16 cm/sec (Fig.4). In most...

Conclusion

Doppler US is a valuable imaging modality in the diagnostic approach to portal hypertensive patients. It provides important information about the hemodynamics status of portal venous system and helps in the management of the disease and its complications.

Personal information

Natália Duarte Ferreira 3rd year Radiology Resident at CHLN - Santa Maria Hospital (Lisbon,Portugal) [email protected]

References

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