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Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance.

Meng Q, Lv L, Yang B, Fu N, Lu G - Radiol Oncol (2012)

Bottom Line: The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing.The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound.

ABSTRACT

Background: To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS). MATERIALS AND METHODS.: Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (V(max)), minimum velocity(V(min)), V(max)/V(min), arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.

Results: The waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.

Conclusions: Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

No MeSH data available.


Related in: MedlinePlus

CTS with severe tricuspid regurgitation. (A) Normal US scans demonstrate normal internal diameters of the portal and hepatic veins (a: right branch, b: left branch c: right hepatic vein, d: middle and left hepatic vein). (B) The waveform of velocity tracing in the intrahepatic branch of the portal vein shows a typical hump-like shape with a transitory hepatofugal tracing (a: right branch, b: left branch). (C) PW displays an increase of retrograde phase of hepatic venous flow with increased velocities in the two phases (a: right hepatic vein, b: middle hepatic vein, c: left hepatic vein). (D) Echocardiography shows an enlarged right atrium with severe tricuspid regurgitation (a: Normal ultrasound scans, b: CDFI, c: PW).
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f5-rado-46-03-198: CTS with severe tricuspid regurgitation. (A) Normal US scans demonstrate normal internal diameters of the portal and hepatic veins (a: right branch, b: left branch c: right hepatic vein, d: middle and left hepatic vein). (B) The waveform of velocity tracing in the intrahepatic branch of the portal vein shows a typical hump-like shape with a transitory hepatofugal tracing (a: right branch, b: left branch). (C) PW displays an increase of retrograde phase of hepatic venous flow with increased velocities in the two phases (a: right hepatic vein, b: middle hepatic vein, c: left hepatic vein). (D) Echocardiography shows an enlarged right atrium with severe tricuspid regurgitation (a: Normal ultrasound scans, b: CDFI, c: PW).

Mentions: Normal US scans and CDFI always showed normal conditions in the portal vein, hepatic veins, and artery. The hepatic veins were sometimes enlarged. The waveform of the velocity tracing in the portal vein, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. PW results displayed an increase in the retrograde phase of hepatic venous flow with increased velocities in the two phases. Echocardiography always exhibited an enlarged right atrium with severe tricuspid regurgitation (Figure 5).


Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance.

Meng Q, Lv L, Yang B, Fu N, Lu G - Radiol Oncol (2012)

CTS with severe tricuspid regurgitation. (A) Normal US scans demonstrate normal internal diameters of the portal and hepatic veins (a: right branch, b: left branch c: right hepatic vein, d: middle and left hepatic vein). (B) The waveform of velocity tracing in the intrahepatic branch of the portal vein shows a typical hump-like shape with a transitory hepatofugal tracing (a: right branch, b: left branch). (C) PW displays an increase of retrograde phase of hepatic venous flow with increased velocities in the two phases (a: right hepatic vein, b: middle hepatic vein, c: left hepatic vein). (D) Echocardiography shows an enlarged right atrium with severe tricuspid regurgitation (a: Normal ultrasound scans, b: CDFI, c: PW).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3472948&req=5

f5-rado-46-03-198: CTS with severe tricuspid regurgitation. (A) Normal US scans demonstrate normal internal diameters of the portal and hepatic veins (a: right branch, b: left branch c: right hepatic vein, d: middle and left hepatic vein). (B) The waveform of velocity tracing in the intrahepatic branch of the portal vein shows a typical hump-like shape with a transitory hepatofugal tracing (a: right branch, b: left branch). (C) PW displays an increase of retrograde phase of hepatic venous flow with increased velocities in the two phases (a: right hepatic vein, b: middle hepatic vein, c: left hepatic vein). (D) Echocardiography shows an enlarged right atrium with severe tricuspid regurgitation (a: Normal ultrasound scans, b: CDFI, c: PW).
Mentions: Normal US scans and CDFI always showed normal conditions in the portal vein, hepatic veins, and artery. The hepatic veins were sometimes enlarged. The waveform of the velocity tracing in the portal vein, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. PW results displayed an increase in the retrograde phase of hepatic venous flow with increased velocities in the two phases. Echocardiography always exhibited an enlarged right atrium with severe tricuspid regurgitation (Figure 5).

Bottom Line: The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing.The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound.

ABSTRACT

Background: To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS). MATERIALS AND METHODS.: Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (V(max)), minimum velocity(V(min)), V(max)/V(min), arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.

Results: The waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.

Conclusions: Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

No MeSH data available.


Related in: MedlinePlus