American Journal of Roentgenology, Vol 155, 785-788, Copyright © 1990 by American Roentgen Ray Society

ARTICLES

Pulsatile portal vein flow: a sign of tricuspid regurgitation on duplex Doppler sonography

MM Abu-Yousef, SG Milam and RM Farner
Department of Radiology, University of Iowa College of Medicine, Iowa City 52242.

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.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				H. J. Lee, K. W. Kim, H. S. Mun, J. H. Kim, G. W. Song, S. Hwang, and S. G. Lee Uncommon Causes of Hepatic Congestion in Patients After Living Donor Liver Transplantation Am. J. Roentgenol., September 1, 2009; 193(3): 772 - 780. [Abstract] [Full Text] [PDF]

				A. Haktanir, B. S. Cihan, C. Celenk, and S. Cihan Value of Doppler Sonography in Assessing the Progression of Chronic Viral Hepatitis and in the Diagnosis and Grading of Cirrhosis J. Ultrasound Med., March 1, 2005; 24(3): 311 - 321. [Abstract] [Full Text] [PDF]

				M Barakat Non-pulsatile hepatic and portal vein waveforms in patients with liver cirrhosis: concordant and discordant relationships Br. J. Radiol., July 1, 2004; 77(919): 547 - 550. [Abstract] [Full Text] [PDF]

				C Gorg, J Riera-Knorrenschild, and J Dietrich Colour Doppler ultrasound flow patterns in the portal venous system Br. J. Radiol., November 1, 2002; 75(899): 919 - 929. [Abstract] [Full Text] [PDF]

				E. G. Grant, L. L. Barr, J. Borgstede, G. A.W. Gooding, U. M. Hamper, B. S. Hertzberg, M. Horrow, R. A. Kane, F. Kremkau, J. W. Meilstrup, et al. AIUM Standard for the Performance of an Ultrasound Examination of the Abdomen or Retroperitoneum J. Ultrasound Med., October 1, 2002; 21(10): 1182 - 1187. [Abstract] [Full Text] [PDF]

				M Barakat Portal vein pulsatility and spectral width changes in patients with portal hypertension: relation to the severity of liver disease Br. J. Radiol., May 31, 2002; 75(893): 417 - 421. [Abstract] [Full Text] [PDF]

				C Gorg, B Wollenberg, and J Beyer Reversed portal vein pulsatility on Doppler ultrasound secondary to an iatrogenic mediastinal haematoma Br. J. Radiol., October 1, 2001; 74(886): 962 - 964. [Abstract] [Full Text] [PDF]