What is DOPPLER PORTAL VEIN?

Sonography and duplex Doppler frequently fail to identify a cause for right upper quadrant pain, liver dysfunction, or ascites. The aim of our study was to describe and analyze the pulsatile portal venous waveform in which minimum velocity dropped to or below zero on duplex Doppler sonography and to investigate its possible association with tricuspid regurgitation, one of the causes of liver dysfunction. We correlated the findings in 15 patients in whom this duplex Doppler waveform was seen with the findings on Doppler echocardiography (n = 14) or ultrafast CT (n = 1). All patients had biochemical liver abnormalities or sudden onset of ascites, rapid weight gain, increased abdominal girth, and hepatomegaly. They were referred for sonography to rule out liver metastases, biliary disease, portal vein thrombosis, or Budd-Chiari syndrome.

All examinations were done with a 3-MHz phased-array sector transducer with duplex Doppler capability. Seventeen volunteers with no known liver or heart disease served as a control group. We correlated maximum and minimum flow velocities on the portal venous Doppler waveform with the portal vein diameters of the study and control groups. Thirteen patients were later proved to have tricuspid regurgitation, one patient had an aortic-right atrial fistula owing to rupture of an aneurysm of the sinus of Valsalva, and one patient was proved to be normal. In none of the 17 control subjects was this pulsatile portal venous waveform seen. Our study shows that detection of a pulsatile portal venous waveform on duplex Doppler sonography in patients with liver dysfunction should raise the possibility of tricuspid regurgitation.

Liver cirrhosis has been a rising complication of chronic liver disease in Singapore. Ultrasound has been widely accepted as a non-invasive imaging modality for the evaluation of hepatic haemodynamics. This study aims to correlate the Doppler ultrasound values with the progression of liver cirrhosis to allow further understanding and possible prediction of clinical events for timely intervention.

The study sample of 56 eligible patients with liver cirrhosis was divided according to their Child-Pugh clinical score into Child’s A (n=29 patients), B (n=19 patients), and C (n=8 patients). The maximum portal vein velocity, maximum hepatic vein velocity, maximum hepatic artery velocity, and hepatic artery resistive index were assessed by Doppler ultrasound.

The incidence of ascites increases with the severity of cirrhosis. Flattening of the hepatic vein waveforms was dependant on the degree of liver cirrhosis. Maximum hepatic vein velocity was higher in cirrhotic patients (where p<=0.05). Maximum portal vein velocity was found to be lower in cirrhosis (where p<0.001) and mean maximum portal vein velocity decreases as the severity of cirrhosis worsens. Hepatic artery resistive index was significantly higher in cirrhosis (where p<0.001). A significant association was found between maximum hepatic vein velocity and maximum hepatic artery velocity and a significant negative correlation was observed with the maximum portal vein velocity and hepatic artery resistive index.