Sonographic findings of portal hypertension

Sonographic findings of portal hypertension

Portal hypertension can be suggested when (1) PV diameter is larger than 13 mm, (2) there is less than 20% increase in the PV diameter with deep inspiration, (3) a monophasic waveform is present, and (4) flow velocity is decreased. Specific measurements may be unreliable given PV diameter variability and the formation of portosystemic collaterals, which often develop in response to portal hypertension, reducing the PV diameter. Common collaterals include (1) a recanalized paraumbilical vein, which runs in the falciform ligament to the abdominal wall and drains the left PV; (2) splenorenal shunts; (3) retroperitoneal veins; (4) hemorrhoidal veins; and (5) the coronary vein, which connects with the portosplenic confluence and ascends to the gastroesophageal junction, producing esophageal varices. A coronary vein diameter larger than 7 mm is highly associated with severe portal hypertension. Retrograde (hepatofugal) PV flow indicates advanced disease and is a useful but late finding 

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