Duplex Doppler ultrasound signs of portal hypertension: relative diagnostic value of examination of paraumbilical vein, portal vein and spleen.

The sonographic parameters in portal hypertension (PHT) were examined in a consecutive population of 118 patients who had PHT diagnosed using specific endoscopic, sonographic and Doppler signs. A patent or enlarged paraumbilical vein was found in 85.6% of patients overall and 82.5% of patients with varices indicating a relatively high sensitivity. A portal vein diameter greater than or equal to 13mm was found in only 41.1% and greater than or equal to 15mm in only 20% of patients. A thrombosed portal vein and reversed portal vein flow were present in 3.4% and 5.3% of patients respectively. These signs have only been reported in the context of PHT and are felt to be specific for PHT, but both have a very low sensitivity. Portal vein velocities were highly variable suggesting that this is not a useful predictor of PHT. Splenomegaly was found in only 53.5% of patients demonstrating its poor sensitivity as a sign of PHT. Varices were found in 73.3% of patients overall, and in 100% of patients with a patent or enlarged paraumbilical vein combined with ascites. No other statistically significant correlation between varices and sonographic findings was demonstrated. We conclude that the presence of a patent or enlarged paraumbilical vein is a practical, useful and sensitive ultrasound sign to look for in the diagnosis of PHT.     

Identification of a patent paraumbilical vein by using Doppler sonography: importance in the diagnosis of portal hypertension

The aim of this study was to determine if the addition of pulsed Doppler imaging to conventional sonography allows discrimination between true paraumbilical veins of portal hypertension and the apparent vein sometimes seen in the ligamentum teres in normal subjects. Conventional sonography and Doppler sonography of the ligamentum teres were performed in 33 normal subjects and in 39 patients with portal hypertension due to chronic liver disease. An apparent ligamentum teres vessel (i.e., hypoechoic channel) was identified on sonograms in 32 (97%) normal subjects (diameter 0.6-1.9 mm) and in 35 (90%) patients with portal hypertension (diameter 1.1-22 mm). In the portal hypertension group, the apparent vessel had a diameter of greater than 3 mm in only 20 patients (51%), but in 32 patients (82%) it was shown on Doppler examination to be a patent paraumbilical vein (i.e., hepatofugal venous signal). A patent paraumbilical vein on duplex Doppler sonography is therefore a specific sign of portal hypertension. The addition of Doppler imaging to conventional sonographic examination significantly increases the sensitivity for the diagnosis of portal hypertension by demonstration of a paraumbilical vein.     

Hemodynamic significance of the paraumbilical vein in portal hypertension: assessment with duplex US

Hemodynamic evaluation of portal and umbilical venous flow with duplex ultrasound (US) was performed in 11 patients with cirrhosis of the liver and a large umbilical vein. Two of these patients had hepatofugal flow in the umbilical vein exceeding hepatopetal flow in the portal vein. These two patients had no evidence of esophageal varices and bleeding. The remaining nine patients had esophageal varices. In these patients, the hepatopetal flow in the portal vein exceeded the hepatofugal flow through the umbilical vein. The authors conclude that duplex US may help identify the massive hepatofugal flow through a large umbilical vein that may reduce the likelihood of esophageal varices and variceal bleeding.     

脐与副脐静脉在门脉高压侧支循环中的意义

Twenty-one postmortem specimens of the liver (18 normal livers, 3 liver metastases) with attached ligamentum teres were investigated using silicone rubber injection technique. In all cases, the paraumbilical veins were demonstrated. They were usually divided into 2 groups, one on the right and the other on the left side of the ligamentum teres, and they terminated in a variable manner into small peripheral portal vein branches in the liver parenchyma. A patent proximal segment of the umbilical vein was found in 7 of the 21 cases. Connections between the umbilical vein and paraumbilical veins were supposed to represent one of the collateral channels in portal hypertension.     

Post mortem CT demonstration of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension

In patients with liver cirrhosis and portal hypertension collateral circulation can develop to direct blood from portal to systemic veins allowing decompression of the portal system. A potential complication of portal hypertension is rupture of collateral vessels with subsequent fatal hemorrhage, occurring most commonly in the esophagus. The paraumbilical vein is a recognized collateral pathway in patients with portal hypertension however cases of rupture have been rarely documented. The authors report a case of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension. Post mortem CT imaging was valuable in localizing the source of hemorrhage in this case.     

Approach to the examination of patients with suspect portal hypertension using duplex ultrasonography. I. Quantitative evaluation of flow in the portal vein

The paper deals with the application of duplex real-time ultrasonography in the area of portal vein system. The attention is centered to the method of quantification of the flow. The author first analyzes the methodology and refers to some main technical factors influencing validity of the results obtained. The author then draws attention to basic ultrasonographic symptoms of portal hypertension. Having analyzed literature data he refers to limited importance of measuring the portal vein flow for the diagnosis of portal hypertension, draws attention to the contribution of respiratory changes in the area of portal vascular bed and the changes in blood flow velocity for this diagnosis. Finally, attention is paid to the possibility of suitable combination of these two signs by creating s. c. "congestive index" (18).     

Macronodular hepatic tuberculosis associated with portal vein thrombosis and portal hypertension

Tuberculosis (TB) of the liver is usually associated with miliary spread. Macronodular TB of the liver is rare. A case of macronodular TB of the liver in a 31-year-old woman causing portal vein thrombosis and portal hypertension is presented. Ultrasound and CT appearances are described. There was coexistent ileo-caecal TB with extensive mesenteric and retroperitoneal lymphadenopathy. Macronodular TB should be considered in the differential diagnosis when a patient presents with multiple calcified masses in the liver with portal vein thrombosis and portal hypertension.     

门静脉癌栓合并门脉高压症的TIPS姑息治疗

目的 评价门静脉癌栓（portal vein tumor thrombosis,PVTT) 合并门脉高压症患者行经颈静脉肝内门体静脉分流术（transjugular intrahepatic portosystemic shunt,TIPS)姑息治疗的疗效，并讨论其技术特点。方法 本组报告14例终末期肝癌合并门静脉癌栓及门静脉高压症患者，平均年龄53．6％。8例门静脉主干完全堵塞，6例门静脉主干及分支有不同程度栓塞，5例合并门静脉海绵样变。1例单纯上消化道大出血，3例单纯顽固性腹水，10例上消化道大出血合并顽固性腹水。结果 14例中10例患者成功行TIPS治疗，门静脉压力平均从术前37.2mmHg(1mmHg=0.133kPa)降至术后18.2mmHg，平均降低19.0mmHg；腹水减少或消失，消化道出血，腹胀，腹泻等症状缓解，平均生存32.3d。4例失败。结论 TIPS是姑息治疗肝癌合并门静脉癌栓引起的上消化道大出血和顽固性腹水的有效方法。     

Doppler ultrasound and portal hypertension: quantitative analysis

Usually, the clinical evaluation of diffuse hepatic changes only needs the answers to three important questions: is there a flow, in which direction and are the porto-caval shunts efficient? When an answer is found to these questions, the quantitative measurement of the portal flow can give complementary precisions to achieve a better physiopathological understanding of portal hypertension or blood malignancies and for the follow-up evaluation.     

Pulsed Doppler duplex sonography and CT of portal vein thrombosis

Five patients with partial or complete portal vein thrombosis were examined by both computed tomography (CT) and pulsed Doppler duplex scanning. Duplex scanning correctly identified portal vein thrombosis in all five. Duplex sonography may be the preferred technique to detect and follow portal vein thrombosis because of lower cost, lack of need for intravenous contrast material, and easier availability for multiple follow-up examinations.     

门静脉内癌栓的超声诊断价值探讨

为探讨门静脉内癌栓在原发病诊断中的价值，现将1999年-2002年随访确诊的52例总结如下，以期提高诊断水平。     

Air in the portal vein: sonographic and Doppler manifestations

Three patients with portal venous gas (one with radiographic and computed tomographic findings) had similar sonographic and Doppler patterns in the portal vein (PV). These patterns consisted of hyperechogenic foci moving within the lumen of the PV, producing sharp bidirectional spikes superimposed on the usual Doppler tracing of the PV. An injection of 0.25-0.50 cm3 of air, oxygen, nitrogen, and carbon dioxide into the jejunal vein of nine dogs yielded identical portal venous sonographic and Doppler patterns. In addition, the liver parenchyma of the dogs became hyperechogenic after the injection of gas. Gas in the PV is accompanied by the following signs: echogenic, moving foci within the lumen of the PV; sharp spikes on Doppler spectral display; and hyperechogenic foci within the liver parenchyma.     

Unusual right umbilical vein collateral in portal hypertension

Umbilical vein collaterals frequently occur in patients with portal hypertension, with the vessels usually connected to the oeft portal system. An umbilical vein collateral draining the right intrahepatic portal system was found in a patient with portal hypertension. This observation has not been previously reported and probably represents persistence of the embryonic right umbilical vein.     

Doppler ultrasound in portal hypertension: qualitative analysis

Duplex Doppler US is a procedure that enables confirmation--and in many instances--detection of portal hypertension by visualizing the presence of collateral blood vessels and determining the direction of the portal flow. In addition, absence of Doppler signal into the veins allows assessment of venous thrombosis both in the portal and hepatic veins.