The portal hypertension of cirrhosis is caused by the disruption of hepatic sinusoids, leading to increased resistance in the portal venous system. Ultrasound is the firstline imaging examination to be performed in patients with suspected cirrhosis andor portal hypertension. The portalvein supplies 7580% of the total hepatic blood to the liver, while the hepatic artery only supplies 20 25%. Portal vein thrombosis is an example of a prehepatic cause of portal hypertension. Pdf ultrasound in portal hypertension part 1 researchgate. Ultrasound images portal hypertension portal hypertension occurs when the pressure in the portal venous system is raised. Managing portal hypertension in patients with liver cirrhosis.
Increased pressure in the blood vessels of the liver, especially the portal vein, can lead to significant complications including internal bleeding. Although ultrasonic anatomy of the upper abdomen related to portal hypertension has been well established with the old handdriven machines 15, the advent of electronically activated parallel transducers for realtime linear scan revolutionized the sonographic approach to hepatobiliary diagnosis 68. Portal hypertension is an increase in the pressure within the portal vein the vein that carries blood from the digestive organs to the liver. To evaluate the liver for acute and chronic liver disease and cirrhosis. Cirrhosis is the most common cause of portal hypertension, but it can also be present in the absence of cirrhosis, a condition referred to as noncirrhotic portal hypertension. Portal hypertension is a term used to describe elevated pressures in the portal venous system a major vein that leads to the liver. Portal hypertension is defined as a portal pressure of greater than 12mm hg or a hepatic venous wedge pressure that exceeds the pressure of the inferior vena cava by 5mm hg. Among the many findings of portal hypertension are enlargement of the portal vein, decreased portal vein velocity, increased congestion index, development of portosystemic collaterals, and reversal of portal vein flow. Sonographic evaluation of the portal and hepatic systems. Portal hypertension is a major pathophysiology in patients with cirrhosis.
Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. Diagnostic performance of ultrasound elastography for. Endoscopy revealed multiple bleeding esophageal\nvarices, and banding procedures were performed. Ultrasound evaluation of portal hypertension duration. Using the specific terms cirrhosis or nodularity, a retrospective evaluation was conducted on abdominal ultrasounds performed between 2008. Portal hypertension management and treatment cleveland.
Ultrasound us is a simple and noninvasive imaging modality available worldwide. Role of ultrasound doppler in evaluation of portal hypertension. When you are first diagnosed with variceal bleeding, you may be. When portal hypertension is confirmed, an endoscopy will be planned to assess whether varices are present. Imaging studies liverspleen scan small liver, irregular uptake splenomegaly colloid shift to bone marrow cat scan ultrasound nodular liver. Prehepatic portal hypertension prehepatic portal hypertension.
Imaging, diagnosis, and endovascular management is the first volume in collaboration between thieme and the sir. A computed tomography scan of\nthe abdomen revealed diffuse fatty infiltration of the liver with evidence of\ nportal hypertension. The most important portal systemic collaterals to focus on with doppler are the coronary vein and. Portal hypertension ph is caused by increased resistance, increased blood flow, or both in the portal circulation. Portal hypertension is difficult to diagnose if symptoms arent obvious. Clinically significant portal hypertension is defined as a gradient greater than 10 mmhg and variceal bleeding may occur at a gradient greater than 12 mmhg. Pdf duplex doppler ultrasonography in portal hypertension.
Portal hypertension 1st edition pdf free download ebook description previously published by the society for interventional radiology sir, this fully revised and updated third edition of portal hypertension. Uk many liver and vascular diseases cause portal hypertension in children table 1, which may give rise to severe and lifethreatening complications, including hemorrhaging from esophageal varices, ascites, hepatopulmonary syndrome, por. Portal hypertension is defined by a pathologic increase in the pressure of the portal venous system. Portal hypertension is defined as a clinical syndrome when portal venous pressure greater than 12 mmhg. The role of ultrasonography in portal hypertension al. Imaging techniques comprise endoscopy, ultrasound, determination of liver stiffness, computed tomography, and magnetic resonance imaging. Nih grants portal hypertension common and less common causes.
Portal hypertension is defined as hepatic venous pressure gradient hvpg greater than 5 mmhg. Portal hypertension an overview sciencedirect topics. Portal hypertension echocardiography and ultrasound wikidoc. An ultrasound can reveal the condition of the portal. Portal hypertension is a relatively common condition, the complications of which are frequently life threatening. Staging of chronic liver disease and portal hypertension. The normal portal vein diameter and portal venous velocity have variable measurement in grayscale and. An assessment of the clinical accuracy of ultrasound in. Ultrasound liver 1 liver and portal hypertension evaluation. Pdf ultrasound in portal hypertension part 2and efsumb. Ultrasound images portal hypertension radiology imaging. The effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning. Increased pressure in the portal vein causes large veins varices to develop across the esophagus and stomach to.
Doppler ultrasound in portal hypertension springerlink. Symptoms include varices, rectal bleeding, vomiting blood, ascites, hepatic encephalopathy, and enlarged spleen. We present two cases in which point of care ultrasound pocus of the hepatic and portal veins contributed to the venous hypertension assessment and decongestive strategy for patients with rightsided heart failure. Portal pressure is the gold standard to evaluate the severity of portal hypertension, and radiological intervention is the only procedure for pressure measurement.
This may happen as a result of chronic liver disease, particularly in the cirrhotic stage, when the nodular and fibrosed nature of the parenchyma impedes the flow of blood into the liver. Portal hypertension develops as a result of blood flow disturbance in any part of the portal channel. Assessment of normal portal vein diameter and velocity using. Portal hypertension is a commonly encountered clinical condition with multiple causes and several sequelae. Portal hypertension and ascites childrens liver disease. However, the accuracy of ultrasound in diagnosing cirrhosis in the absence of portal hypertension has not been well studied.
Ultrasonography for noninvasive assessment of portal hypertension. The collateral vessels formed are thin walled and prone to rupture. Ultrasonography for noninvasive assessment of portal. Color and power doppler us cdus is 90 % accurate for diagnosing portal vein thrombosisportal cavernomas and hepatic vein disturbances buddchiari. Imaging and pathological features of idiopathic portal. Screenings such as a doppler ultrasound are helpful. Each bleeding episode carries up to a 20% risk of death. Duplex doppler ultrasonography in portal hypertension article pdf available in journal of medical ultrasound 152.
Ultrasound is safe, can be repeated easily, is not expensive and is highly sensitive in detecting thrombosis in the portal vein and hepatic veins, so allowing a correct differential diagnosis of new cases of portal. Teefey, md, facr professor of radiology mallinckrodt institute of radiology washington university school of medicine saint louis, missouri financial disclosures. Ultrasound is an accurate noninvasive means of assessing its aetiology, severity and complications but in order to maximise diagnostic accuracy a systematic and thorough approach is advised involving assessment of the liver, spleen, portal and hepatic. Liver stiffness measurement predicts severe portal hypertension in patients with hcvrelated cirrhosis. Portal hypertension diagnostic imaging and imaging. Portosystemic collaterals varices with rising portal venous pressure 15 mmhg, anastomoses between the highpressure portal circulation and the lowerpressure systemic system form to shunt blood away from the portal system. The following shows the most common causes of portal hypertension. Ultrasound signs of portal hypertension competently. However, fundamental tissue images are available only using bmode sonography. Patient a was 91 years old with known pulmonary hypertension.
Findings on an echodoppler suggestive of portal hypertension include lack of increase in portal vein diameter in response to meals, increased portal blood flow velocity, and decreased portal vein cross. In contrast, the sensitivity of the method, assessed on the basis of portal dilatation, was only 41. An ultrasound scan this is the same scan pregnant women have. Pdf ultrasound in diagnosis of portal hypertension v. The increase in pressure is caused by a blockage in the blood flow through the liver. Doppler ultrasound us evaluation of splanchnic hemodynamics has proved to be of enormous value in the diagnostic approach to portal hypertensive patients. Portal venous pressure an overview sciencedirect topics. New doppler ultrasound signs improve the noninvasive diagnosis of. For staging of chronic liver disease, a variety of different tools are available, including physical examination, laboratory tests, imaging techniques, and hemodynamic measurements figure 2. Portal hypertension may be caused by intrinsic liver disease, obstruction, or structural changes that result in increased portal. Pdf on dec 1, 2011, a berzigotti and others published ultrasound in portal hypertension part 1 find, read and cite all the research you. One of the main reasons for the development of portal hypertension is the presence of an obstacle to the current of portal blood in the liver or in the vessels of the portal vein system, respectively, which distinguish. Anatomy portal vein pv is the main vessel in the portal venous system and drains blood from the gastrointestinal tract and spleen to the liver.
Ultrasonography in the diagnosis of portal hypertension. The sensitivity of ultrasound in detecting portal hypertension, based on the measurement of caliber variation, was 79. Portal hypertension is increased blood pressure in the blood vessels that lead to the liver. Portal hypertension may be caused by intrinsic liver disease, obstruction, or structural changes that result in increased portal venous flow or increased hepatic resistance. Doppler ultrasound evaluation in portal hypertension epos. It is used to measure the size of the liver and the spleen. Although rtus is also utilized in the evaluation of portal hypertension by measuring the. Patients with right heart failure pose significant volume management challenges for hemodynamic optimization. Portal hypertension ph represents an increase of the hydrostatic pressure wi. The role of this simple technique for portal hypertension is to. To study the spectrum of ultrasound doppler findings in portal hypertension, its various aetiology, complications and the flow metric changes. Ultrasound is an invaluable tool for the diagnosis of hepatocellular carcinoma and portal hypertension. In portal hypertension imaging, ultrasound techniques such as duplex ultrasonography or spectral doppler imaging and color doppler imaging or power doppler imaging are the modalities of choice, because they are noninvasive, rapid, and highly sensitive and specific.
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