Portal Venous System: Sonographic Evaluation and Disease

Question 1

Hepatic Veins

Answer 1

Thin walls
Increase in diameter as they near IVC
Flow away from liver
Course inferior to superior

Question 2

Portal Veins

Answer 2

Thick, reflective walls.
Constant diameter.
Flow toward liver.
Course transversely thru the liver.

Question 3

The portal vein can become biphasic with

Answer 3

hepatic congestion, CHF or significant tricuspid regurgitation.

Question 4

SMV

Answer 4

The blood flow in the splenic vein is normally hepatopetal.

Question 5

Flow in the hepatic artery and the portal vein should be

Answer 5

hepatopetal. The hepatic artery and portal vein normally carry blood into the liver. The PW Doppler tracing demonstrates the portal vein is retrograde and the hepatic artery is antegrade which is indicative of severe portal HTN.

Question 6

Cavenous Transformation

Answer 6

Note that the numerous tiny vessels surrounding the portal vein. These varices dilate with the increased pressure in the portal system with portal HTN.

Question 7

Transjugular Intrahepatic Portosystemic Shunt

Answer 7

In order to relieve severe portal HTN, a synthetic shunt is connected from the portal system through the liver tissue and into the hepatic veins or (IVC). It is usually introduced into the body by inserting a catheter into the jugular vein.

Question 8

TIPS

Answer 8

Note the normal blood flow in the shut is from the portal vein to the hepatic vein/IVC.

Question 9

TIPS- Normal flow

Answer 9

Normal flow in the TIPS is demonstrated from the portal vein to the hepatic system

Question 10

TIPS Normal PW doppler

Answer 10

Normal flow in the TIPS is demonstrated from the portal vein to the hepatic vein.

Question 11

Abnormal Transjugular Intrahepatic Portosystemic Shunt

Answer 11

Note the turbulent flow in the distal shunt caused by a stenosis at the hepatic vein anastomosis.
Note the increaseing velocity of hte flow within the shunt as it nears the hepatic vein anastamosis. Normal velocities should not exceeed 200 cm/s.
Note the flow reversal into the hepatic vein caused by teh stenosis at the hepatic vein anastomosis.

Question 12

Portal HTN is most commonly caused by

Answer 12

cirrhosis

Question 13

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is the most common

Answer 13

portocaval shunt

Question 14

Thromboisis is the most common cause of

Answer 14

acute shunt stenosis/ occlusion

Question 15

The most common site of TIPSS stenosis (chronic occlusion) is at the

Answer 15

hepatic vein anastomosis.

Question 16

Neointimal hyperlasia is the most common cause of

Answer 16

graft stenosis/occlusion

Question 17

The most common site for hepatic artery stenosis in a transplant is at teh

Answer 17

native hepatic artery anastamosis site located just outside the hilum of the liver.

Question 18

Most common variant of celiac axis anatomy is the

Answer 18

hepatic artery originates from SMA, instead of the Celiac axis.

Question 19

The splenic artery is the most common site of

Answer 19

aneurysm of a visceral vessel and these aneurysms are most common in females.

Question 20

Tumor invasion of the IVC most commonly occurs with

Answer 20

renal cell carcinoma

Question 21

Renal vein thrombosis is most commonly caused by

Answer 21

primary renal disease