OBJECTIVE. Cavernous transformation of the portal vein is defined as the formation of venous channels within or around a previously thrombosed portal vein. The purpose of this work was to study the hemodynamic consequences of cavernous transformation of the portal vein in a group of afflicted patients by use of Doppler sonography. We wished to study the evolution from portal vein thrombosis to the formation of cavernous transformation, the extent of resulting extrahepatic collateral channels, and the patterns of splanchnic collateral circulation. MATERIALS AND METHODS. Seventy-five patients (48 adults and 27 children) with cavernous transformation of the portal vein were studied with color and/or pulsed Dop-pIer sonography. Blood flow in the extrahepatic portal vein, in its segmental branches, in the hepatic veins and artery, and in the splanchnic veins was examined. Collateral pathways were sought. For nine patients with acute thrombosis of the portal vein, serial examinations were performed during the formation of cavernous transformation. RESULTS. In nine patients, a fresh thrombus filled and distended the portal vein and became recanalized within a few days. Tortuous vessels appeared at the porta hepatis. These were characterized as veins or arteries with Doppler sonography. Soon the pertal vein could no longer be identified within the mass of tortuous vessels. The cavernous transformation developed within 6-20 days of the acute thrombosis. A spongelike

The purpose of this study was to determine the prevalence and localization of focal areas of sparing in a population of patients with fatty infiltration (steatosis) of the liver. We also sought to determine if the blood supply of the gallbladder has an effect on fatty infiltration of the liver adjacent to it. We studied 290 patients with sonographic signs of fatty infiltration of the liver with gray scale sonography. In 58 of the patients, the gallbladder had been removed previous· ly. A zone of focal sparing was found in 67% of patients with liver steatosis (78~ in patients with an intact gallbladder versus 33% in patients with previ· ous cholecystectomy). In patients with an intact gallbladder, segments 4 and 5 were spared most often. These segments were rarely spared in patients with previous cholecystectomy. Other sites of focal sparing were observed with the same frequency in the two groups. We conclude that focal sparing occurs frequently in patients with liver steatosis, especially in segments 4 and 5. When the gallbladder is absent, areas of focal sparing are less frequent, and they rarely involve segments 4 and 5. This suggests that the blood supfly of the gallbladder plays a role in the distribution o the fat in the adjacent liver. Focal sparing might serve as an additional sign in the diagnosis of steatosis of the liver, especially in patients with an intact gallbladder. KEY WORDS: Steatosis; Liver, fatty infiltration; Gallbladder.diffuse, but focal areas of sparing have been described in several small series, in what appears to be exceptional cases.2-6 We attempted to determine (1) the prevalence of focal sparing in a large population of patients with steatosis; (2) whether there are areas in the liver that are usually spared, and (3) whether the gallbladder and its vascularization favor the sparing of liver parenchyma from fatty infiltration. MATERIAL AND METHODSOver a period of 12 months, all patients undergoing abdominal sonography were examined by two experienced radiologists. Patients in whom sonographic signs of steatosis were found were included in the study. Patients with metastasis or a liver tumor were excluded. The study group consisted of 137 men

The purposes of this study were to look for the inferior mesenteric artery in patients undergoing abdominal sonography, to determine in what percentage of patients it is visible, and to characterize Doppler flow patterns of the inferior mesenteric artery in fasting patients without intestinal vascular disease. The inferior mesenteric artery was sought in 100 consecutive fasting adults (mean age, 54 years; 63 women, 37 men), as follows: the infrarenal aorta was scanned in a transverse plane; the origin of the inferior mesenteric artery was identified on the left anterolateral surface of the aorta; the inferior mesenteric artery was then traced caudally along the left side of the aorta. The inferior mesenteric artery and the superior mesenteric artery were studied with Doppler sonography in 50 different subjects without clinical or Doppler sonographic evidence of abdominal vascular disease (mean age, 44.9 years; 17 men, 33 women). Pulsed Doppler samples were taken within the inferior mesenteric artery in sagittal planes. The resistive index was calculated from the superior mesenteric artery and the inferior mesenteric artery. The inferior mesenteric artery was detected in all but eight patients (92%). In seven patients obesity prevented visualization. The eighth patient had undergone abdominal surgery on the previous day, limiting the sonographic examination. The diastolic flow in the inferior mesenteric artery was less than that in the superior mesenteric artery in all patients. The resistive index was 0.959 +/- 0.045 in the inferior mesenteric artery and 0.856 +/- 0.046 in the superior mesenteric artery (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)