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A 45-year-old woman was brought into the emergency ward of a tertiary care hospital. The patient gave a history of excess bleeding and passage of clots per vaginum since the past 15 days. The patient had a history of severe headaches, body ache, giddiness and vomiting. She was diagnosed with idiopathic thrombocytopenic purpura (ITP) and severe anemia six months before this incidence. The authors performed a diagnostic pelvic and transvaginal ultrasound and reported the presence of uterine fibroids. They determined that these fibroids had aggravated the bleeding which was caused by ITP. The diagnosis of ITP coupled with severe anemia prevented the authors from using the traditional approach of a hysterectomy in such a case. She was administered tranexamic acid, testosterone enanthate, blood, intravenous immunoglobulins, steroids and platelets transfusion. Uterine artery embolization (UAE) was tried for arresting menorrhagia, but was unsuccessful. Finally, a Bakri® balloon, normally used for management of post-partum hemorrhage (PPH), was inserted and retained for 48 hrs.. The bleeding gradually ceased and significant improvements in hematocrit and platelet count were observed. However, the patient then suffered from a deep vein thrombosis (DVT) in the lower extremity, which was treated with low molecular weight heparin (LMWH), a thrombectomy and an Inferior vena cava Filter. Patient was advised a hysterectomy to curb her symptoms, however, she was too exhausted of surgical procedures and refused. Therefore, the authors decided to employ the use of Selective Estrogen Receptor Molecule Therapy (SERM). 3-months post-intervention, patient is thriving and stable.

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Color Doppler sonography is an important noninvasive procedure for detecting abnormalities in hepatic vasculature in various liver diseases. Ultrasound findings associated with portal hypertension include enlarged diameter of the portal vein, lack of respiratory variation in the portal vein or its tributaries, hepatofungal portal flow direction, decreased portal velocity or volume, and the presence of collaterals or varices. Not only portal hypertension but various other liver diseases are associated with abnormalities noted in hepatic vasculature. An abnormal liver texture and ascites are also commonly seen and are usually related to accompanying cirrhosis. PORTAL VEIN: The portal vein is seen in about 97% of normal patients; failure to visualize it can suggest the presence of pathology, such as thrombosis. No intraluminal echoes with frequent echogenic border. HEPATIC ARTERY: Proximal hepatic artery is best seen at celiac trunk while distal hepatic artery is seen at the level of main portal vein. On Doppler assessment low resistant waveform pattern is seen with systolic and diastolic component. IVC (INFERIOR VENA CAVA): Normal IVC has Low level intra luminal echoes within the lumen and changes occur during respiration. On Doppler assessment continuous triphasic waveform with respiratory variation. HEPATIC VEIN: Color Doppler is a key tool, since the hepatic veins may be difficult to visualize with B-mode imaging alone when the liver is enlarged or cirrhotic. AIM: To evaluate the abnormalities of hepatic vessels and portal vein in various liver diseases and role of colour Doppler in portal and hepatic vessels various liver disease with histopathological correlation. MATERIAL AND METHOD: A prospective study and is conducted in Department of Radiodiagnosis, N.S.C.B. Medical College, Jabalpur M.P.), over a period of one year (2011)(2012). To evaluate the colour Doppler of hepatic vessels and portal venous system in liver disease with pathological correlation. INCLUSION CRITERIA: All patients (M/F of all age group) having liver diseases (Medical or Surgical) as diagnosed on various investigations, using curvilinear and linear probe of machine (Wipro GE (Logic 3 Expert-Ay15CUK) and Siemens (Sonoline G-50)). First 2D sonography was conducted and then color Doppler assessment of various vessels including Portal vein, hepatic artery and hepatic vein, inferior vena cava was done. RESULTS: Liver pathology was evaluated by 5 and 10 MHz electronically focused curvilinear and linear transducer with patient in supine position with direct contact method. The age ranges from 8 to 73 years. Most common age group affected was between 50 to 60 years. In this study 26(57.7%) cases were male and rest of 19(42.2%) cases was female. out of these 45 cases, 29(64.4%) cases were from rural area and rest of 16(35.5%) cases belonged to urban area. In our study 11(24.4%) cases had positive history of various types of addiction. Most common presenting complaint was abdominal pain which is found in 35(76%) cases. In present study o...