Splenorenal collateral, portal hypertension - Color Ultrasound
Title: Color Ultrasound - Splenorenal collateral, portal hypertension
Diagnosis: Splenorenal collateral, portal hypertension
Author: Dr.ROSSET Antoine
Comment: Dr. KHAN Haleem
Chapter: Liver & Spleen
Clinical Presentation: Alcoholic cirrhosis. High GIbleed.
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: Multiple tortuous tubular cystic structures are seenin the splenic hilum
and left renal hilum. Color Doppler confirmsthese structures as splenorenal
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