Portal Hypertension

Authors' Reply

“…We agree that ultrasonography must be con sidered the first meth od of evaluating children suspe cted to have portal hype rtension. Even if our (1) and other experiences (2,4), includin g that of Dr. da Silveira, showed that the measur ement of the lesser omental thickness is the most sensitive marker of the pre sence of esophageal varices in children, we agree with Rabinowitz et al ( 5) that additional sonographic criteria might be useful to improve the predictivity of ultrasound in the diagno sis of portal hyperten sion . LOTLV, lesser omentum thickness at the level of ligamentum venosum; LOTAO, lesser omentum thickness between the posterior surface of the liver and the anterior surface of the aorta; AO, aorta; PV, portal vein.…”

“…An algorithm ic approach was also hypothesized . Regarding the methodology of the study by Dr. da Silveir a and colleague s, we emphasize that all authors working on thi s topic ev aluated the lesser omental thickness at the level of the celiac axis and not at the level of the ligamentum venosum , which may sometimes be mistaken for the lesser omentum (2). In addition, the measurement of the lesser omental thickness has always been related to aortic diameter, measured in the same scan, and expressed as ratio .…”

“…' We appreciate the interest of Dr. da Silveira et al in our paper (1), showing the efficacy of ultrasonography in the diagno sis of esophageal varices in children. In that study we evaluated two ultrasonographic markers: (a) the ratio between lesser omental thickness and aortic diameter, mea sured at the level of the celiac axis, as pre viously sugges ted in children (2); and (b) the size of port al vein, a sonographic marker proposed in adults with portal hypertension (3). Thi s marker was considered of doubtful value in the pediatric age, because it is age-dependent (2).…”

“…In that study we evaluated two ultrasonographic markers: (a) the ratio between lesser omental thickness and aortic diameter, mea sured at the level of the celiac axis, as pre viously sugges ted in children (2); and (b) the size of port al vein, a sonographic marker proposed in adults with portal hypertension (3). Thi s marker was considered of doubtful value in the pediatric age, because it is age-dependent (2). For this reason, in our study the size of the portal vein was related to the body surface (PV/m 2 ratio ).…”

“…Last, no attempt was made to compare the ultrastructure of the particles in their patient with published reports of measles virus structure, with which there are some discrepancies (2).…”