Color doppler sonographic evaluation of spontaneous portosystemic shunts and inversion of portal venous flow in patients with cirrhosis

Abstract

Purpose The aim of the study was to evaluate the usefulness of color Doppler sonography in the detection of spontaneous portosystemic shunts and abnormal blood flow direction in the portal vein in patients with cirrhosis. Methods Patients were 67 men and 42 women (mean age, 53 ± 14 years) with cirrhosis confirmed by liver biopsy. All patients underwent abdominal gray‐scale and color Doppler sonographic evaluations to detect the presence of spontaneous portosystemic shunts and to analyze portal vein blood flow direction. Results Spontaneous portosystemic shunts were found in 41 patients (38%), most often as splenorenal shunts (21%) and patent umbilical veins (14%). Less frequent were gastric collaterals, gallbladder varices, collaterals to thrombotic portal veins, mesoiliac shunts, and portorenal shunts to the right kidney. The presence of shunts was associated with that of esophageal varices (p < 0.01), ascites (p < 0.01), and inversion of portal flow (p < 0.001) but not with splenomegaly. The direction of portal venous flow was normal (hepatopetal) in 80 patients (73%), hepatofugal in 10 (9%), and bidirectional in 7 (6%); 12 patients (11%) had partial portal vein thrombosis. Conclusions Portosystemic shunts and the direction of portal venous flow are important features in the sonographic diagnosis of portal hypertension. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:332–339, 2000.

Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension

“…Our results show that among the most commonly evaluated US signs of portal hypertension, abdominal porto-systemic collaterals can be considered an equivalent of very severe portal hypertension, and are associated with first decompensation and mortality at univariate analysis. APC have been previously identified as a highly specific sign of portal hypertension in cirrhotic patients [27], and are more frequently observed in patients with decompensated disease and in patients with gastroesopheageal varices [28]. Their appearance in patients with no or small varices suggests worsening of endoscopic signs of portal hypertension [29].…”

Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance

“…1 Color Doppler sonography (CDS) is a very important tool for assessing the presence, size, and location of PSs and obtaining a picture of portal hemodynamics. [2][3][4] In particular, CDS allows for the visualization of the umbilical vein (UV), the left gastric vein (LGV), spontaneous splenorenal shunts (SRS), combined shunts (CSs), and blood fl ow direction in both the portal vein and collateral trees.…”

Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients

“…No simple noninvasive method which accurately predicts esophageal variceal bleeding is available so far and endoscopists have had to perform endoscopy every 3 to 6 mo to evaluate patients with previously bleeding esophageal varices [5,6] . However, this approach is costly and not all patients with liver cirrhosis and esophageal varices are good candidates for such procedures [7] .…”