Alcoholic cirrhosis with portosystemiccollaterals - Color Ultrasound
Title: Color Ultrasound - Alcoholic cirrhosis with portosystemiccollaterals
Diagnosis: Alcoholic cirrhosis with portosystemiccollaterals
Author: Dr.ROSSET Antoine
Comment: Dr. KHAN Haleem
Chapter: Liver & Spleen
Clinical Presentation: Alcoholic cirrhosis with an increase inabdominal
circumference due to ascitis. Upper GI bleeding due togastroesophageal varices.
Comment: Cirrhosis is the most common cause of intrahepaticportal hypertension.
Sonographically, several patterns areencountered. Volume redistribution with relative
atrophy of theright lobe and hypertrophy of the left lobe or caudate lobe may beseen. The
echostructure is coarse and the surface is nodular.Ultrasound does not allow accurate
differentiation betweenregenerating and dysplastic nodules. MR and percutaneous biopsy
maybe necessary to exclude a hepatocellular carcinoma. Ascites andsplenomegaly are
noted. Five major sites of portosystemiccollaterals are visualized by ultrasound:
Gastroesophagealjunction, para umbilical vein, splenorenal and gastrorenal,intestinal and
hemorrhoidal. The normal portal vein displays anundulating hepatopedal flow with a flow
velocity of 15-18 cm/sec.With portal hypertension the flow becomes monophasic,
biphasic andfinally hepatofugal. Intrahepatic arterial portal venous shuntingcan be seen.
The triphasic waveform of the hepatic veins may bealtered in cirrhosis: decreasing in
amplitude with loss of flowreversal or a flattened waveform. Luminal narrowing of the
hepaticveins can result in color aliasing and turbulence. In patients withcirrhosis the
increase in the resistive index by hepatic arteryvasoconstriction after a meal is blunted.
Some US criteria: Portalvein >13mm (50 % sensitivity, 100 % specificity)
Recanalizedumbilical vein > 3mm Loss of respiratory increase of splanchnicvein diameter
(80 % sensitivity, 100 % specificity) Hepatofugalvenous flow (80 % sensitivity, 100%
specificity) Cavernoustransformation of portal vein Increased echogenicity and
thickeningof portal vein Splenomegaly Ascites
Description: The B mode scan shows a cirrhotic liver with a nodularsurface and a
coarse echotexture of the parenchyma. Dopplerdemonstrates a hepatofugal flow in the
portal vein(coded in blueand thus flow is away from the probe). Inversed flow is also
seenin the splenic vein and superior mesenteric vein. Portosystemiccollaterals are also
detected: splenorenal and gastro renal veins.The para umbilical vein is also patent. These
vessels are tube likecystic structures demonstrating monophasic venousflow.
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