Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused by portal hypertension, systemic venous enlargement caused by cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.

No abstract

With the advent of real time scanners, segments of the normal biliary tree can now be seen regularly. Normally, the biliary junction is narrower than the portal vein or the portal division. With early dilatation of the bile ducts the diameters of the two systems tend to equalize. Thus, the presence of two parallel ducts with similar diameters is pathologic. As the dilatation of the biliary tree progresses, the portal system may become flattened, thus reversing the initial proportion between the diameter of the biliary junction and that of the biliary tree.

No abstract

In about 10% of lymphopathies with extensive retroperitoneal adenopathies, adenopathies are also encountered within the hepatoduodenal ligament. When large, such adenopathies, which surround the portal vein, hepatic artery, and bile duct, give rise to a particular ultrasound pattern: the "rosebud pattern."