Hepatofugal portal flow on Doppler sonography in various pathological conditions: A pictorial essay

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.

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“…9 ), and perisplenic varices. Gastrorenal and splenorenal shunts are other examples of varices [ 20 ].…”

Section: Portal Venous Flow Patterns In Cirrhosismentioning

confidence: 99%

Altered Doppler flow patterns in cirrhosis patients: an overview

et al. 2016

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“…6,7 Many of the reported cases of hepatofugal portal venous flow were caused by iatrogenic trauma during transhepatic procedures, resulting in a direct arterioportal communication. [8][9][10][11] However, as mentioned above, we excluded these cases because we wanted to examine hepatofugal portal venous flow associated with the global graft status.…”

Section: Discussionmentioning

confidence: 99%

“…The phenomenon of hepatofugal portal venous flow results from the complexity of the hepatic sinusoidal system, and its main cause is either overflow from the hepatic artery to the portal vein (eg, arterioportal fistula or peritumoral shunt) or reversal of the pressure gradient between the hepatic sinusoid and portal vein (eg, portal hypertension due to liver cirrhosis) 6 , 7 . Many of the reported cases of hepatofugal portal venous flow were caused by iatrogenic trauma during transhepatic procedures, resulting in a direct arterioportal communication 8 – 11 .…”

Section: Discussionmentioning

confidence: 99%

Hepatofugal Portal Venous Flow on Doppler Sonography After Liver Transplantation

Jeong

Kim

Lee

et al. 2012

Journal of Ultrasound in Medicine

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Objectives The purpose of this study was to categorize hepatofugal portal venous flow on Doppler sonography after liver transplantation and to investigate its clinical importance and presumed causes based on radiologic and pathologic findings. Methods This retrospective study was approved by our Institutional Review Board, and the requirement for informed consent was waived. Examination of our database over 4 years revealed 30 patients in whom Doppler sonography showed hepatofugal portal venous flow during follow‐up periods. We investigated its occurrence and clinical features, including radiologic and pathologic findings, and classified the possible causes into 5 types: A, systemic problems; B, gross vascular abnormalities correctable by intervention; C, specific cardiac problems; D, microscopic abnormalities of the graft; and E, miscellaneous. We classified the patterns of hepatofugal portal venous flow into continuous hepatofugal or hepatofugal‐dominant to‐and‐fro flow and hepatopetal‐dominant to‐and‐fro flow, and we investigated the relationship of the presumed causes and flow patterns with the clinical course. Results The incidence of hepatofugal portal venous flow was 2.38%. The overall mortality rate was 26.67% (95% confidence interval, 11.1%–42.9%): all patients (n = 5) in group A, 1 in group C, and 2 in group D, died. Possible cause type B and a mainly hepatopetal flow pattern were good prognostic factors (P = .031 and .018, respectively). Conclusions Hepatofugal portal venous flow reflects diverse pathologic conditions after liver transplantation, and its clinical importance also differs depending on the cause.

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Hepatofugal portal flow on Doppler sonography in various pathological conditions: A pictorial essay

Cited by 2 publications

References 51 publications

Altered Doppler flow patterns in cirrhosis patients: an overview

Altered Doppler flow patterns in cirrhosis patients: an overview

Hepatofugal Portal Venous Flow on Doppler Sonography After Liver Transplantation

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