Title: Role of Duplex Ultrasonography in the Evaluation of Portal Venous Hypertension
Authors: Rajesh Pattanaik, Bararuchi Dash, Shamimun Nisa, Braja Behari Panda, Savitri Bhagat, Soumya Ranjan Nayak
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.110
Abstract
Aims & Objectives: The objective of our study is to know the spectrum of colour Doppler and ultrasonographic findings in portal hypertension & to assess the value of duplex ultrasonography to diagnose & establish the cause of portal hypertension.
Materials & Methods: A Cross-sectional study was conducted from December 2014 to November 2016 on 100 clinically suspected / diagnosed cases of portal hypertension, who were referred to our department. All the patients underwent 2D grey scale & colour doppler ultrasonography of abdomen and pelvis using a curvilinear probe of 3.5 – 5.0 MHZ. Analysis of Percentage and proportions of various morphologic & hemodynamic parameters & etiology of portal hypertension were done.
Results: Among 100 cases of portal hypertension who were studied, 72% were males & 59% in age group of 40 to 59 yrs. Most common etiology of portal hypertension was Cirrhosis (71%). Portal vein diameter >13 mm was seen in 61% of cases. Loss of respiratory phasicity of portal vein was seen in 84% cases. Decreased portal vein velocity was noted in 44% cases. Congestion index >0.1 seen in 92% of cases. Hepatopetal, hepatofugal and bidirectional to and fro flow was noted in 78%, 4% and 3% respectively. Among Porto-systemic collaterals was noted in 92% of the cases most common being spleno-renal and gastro-renal collaterals, seen in 87% of cases. Splenomegaly and ascites were seen in 93% and 85% cases respectively.
Conclusion: Portal hypertension is a commonly encountered clinical condition with multiple causes and several sequelae. Ultrasound is an accurate non-invasive tool giving significant hemodynamic information and helps in assessing etiology, severity and complications of Portal Hypertension.
Keywords- Portal Hypertension, duplex ultrasonography, cirrhosis, Porto-systemic collaterals.
References
1. Rumack CM , Wilson SR , Charboneau JW , Levine D. The Liver .In:Wilson SR, WithersCE , editors. Diagnostic Ultrasound, 4th ed. Philadelphia: Elsevier Mosby; 2011. P78-145.
2. Fernandez Perez FJ, García Montes JM, Castro Laria L, Martin Guerrero JM, Jimenez Saenz M, Herrerías Gutierrez JM.Usefulness of ultrasonography in the diagnosis of portal hypertension.RevEspEnferm Dig. 1998 Nov;90(11):806-812.
3. Sama SK, Bhargawa S, Gopi N et al. Non cirrhotic portal fibrosis.[4] Am J Med. 1971; 51: 160-69.
4. Sarin SK, Sachdev G. Nanda R. Follow up of patients after [5]variceal eradication. A comparison of patients with cirrhosis, non-cirrhotic portal fibrosis and extrahepatic obstruction. Ann Surg. 1986: 204; 78-82.
5. Gorg C, Riera-Knorrenschild J, Dietrich J. Pictorial review: Color [8]Doppler ultrasound flow patterns in the portal venous system. Br J Radiol. 2002;75:919–29.
6. Owen C, Meyers P. Sonographic evaluation of the portal and [9]hepatic systems. J Diag Med Sonography. 2006; 22(5)317-28.
7. Bolondi L, Mazziotti A, Arienti V. Ultrasonographic study of portal [10]venous system in portal hypertension and after portosystemic shunt operations. Surg. 1984; 95(3):261-69.
8. Zoli M, Dondi C, Marchesini G, Cordiani MR, Melli A, Pisi E. Splanchnic vein measurements in patients with liver cirrhosis: A case control study. J Ultrasound Med. 1985; 4:641.
9. Kurol M, Forsberg L. Ultrasonographic investigation of respiratory influence on diameters of portal vessels in normal subjects. Acta Radiol Diagn (Stockh). 1986; 27:675.
10. LaFortune M, Marleau D, Breton G. Portal venous system [13] measurements in portal hypertension. Radiol. 1984; 151:27.
11. Koslin B. Duplex Doppler in portal hypertension. [14] Semin – Ultrasound and CT, MR. 1992; 13:22-33.
12. Pellerito JS, Polak JF. Ultrasound assessment of the hepatic vasculature In: Middleton WD, Robinson KA, editors. Introduction to vascular ultrasonography. 6th ed. Philaelphia: Elsevier Saunders;2012.P495-516.
13. Leeven V. Doppler ultrasound: Clinical applications. Radiol. 1990; 174:309-19.
14. Yazdi HR, Khalilian MR. Sonograhic assessment of respiratory variations in diameter of portal and splenic veins in cirrhotic patients and healthy controls. Iran J Radiol. 2005;2(3,4):95-98.
15. Patriquin H, Lafortune M, Burns PN, Dauzat M. Duplex Doppler examination in portal hypertension : Technique and Anatomy. AJR.1987;149:71.
16. Takayasu K, Takashi M, Musha H. Spontaneous reversal of portal blood flow demonstrated by percutaneous transhepatic catheterization: Report of two cases. Gastroenterol. 1982; 82:753.
17. Herbay AV, Frieling T, Haussinger D. Color Doppler sonographic evaluation of spontaneous portosystemic shunts and invesion of portal venous. J Clin Ultrasound. 2000;28(7):332-39.
18. F. Moriyasu, et al.: Congestion index of the portal vein. AJR Am J Roentgenol. 146:735-739 1986
19. Haag K, et al.: Correlation of duplex sonography findings and portal pressure in 375 patients with portal hypertension. AJR Am J Roentgenol. 172:631-635 1999.
20. Vilgrain V, Lebrec D, Menu Y, Scherrer A, Nahum H. Comparison between ultrasonographic signs and the degree of portal hypertension in patients with cirrhosis. GastrointestRadiol 1990;15:218-22.