Related Experiment Videos
Hepatic venous outflow obstruction: evaluation with pulsed duplex sonography
T Hosoki1, C Kuroda, K Tokunaga
1Department of Radiology, Osaka University Medical School, Japan.
Insights
Pulsed Doppler sonography effectively evaluates hepatic outflow obstruction, distinguishing Budd-Chiari syndrome from hepatic venocclusive disease by analyzing blood flow patterns in key veins. This non-invasive technique offers valuable hemodynamic insights.
Area of Science:
- Medical Imaging
- Vascular Ultrasound
- Hepatology
Background:
- Hepatic outflow obstruction encompasses conditions like Budd-Chiari syndrome and hepatic venocclusive disease, characterized by impaired blood flow from the liver.
- Accurate hemodynamic assessment is crucial for diagnosis and management of these complex vascular disorders.
Observation:
- Pulsed Doppler sonography was utilized to examine blood flow dynamics in the inferior vena cava (IVC), hepatic veins, collateral veins, and portal vein in six patients.
- Specific attention was paid to alterations in flow patterns, including absence, reversal, turbulence, and velocity changes.
Findings:
- In Budd-Chiari syndrome, Doppler revealed abnormal flow in the IVC and hepatic veins (absent, reversed, turbulent, or continuous), with reduced portal vein velocity being typical.
- Hepatic venocclusive disease presented with normal IVC and hepatic vein flow but increased portal vein velocity.
Implications:
- Doppler sonography demonstrates significant utility in characterizing hemodynamic changes associated with hepatic outflow obstruction.
- Findings correlate well with therapeutic outcomes and angiographic data, supporting its role in clinical decision-making.
- This non-invasive method aids in differentiating between Budd-Chiari syndrome and hepatic venocclusive disease.
Abstract:
Pulsed Doppler sonography was performed in six patients with hepatic outflow obstruction (five with Budd-Chiari syndrome and one with hepatic venocclusive disease) to assess its usefulness in evaluating the altered hemodynamics in this disease. Doppler signals were obtained from the inferior vena cava (IVC) and from hepatic, collateral, and portal veins. Normally, the IVC and hepatic veins show phasic forward (toward the heart) flow. In Budd-Chiari syndrome, the blood flow in the IVC and hepatic veins was absent, reversed, turbulent, or continuous. These Doppler findings were thought to be characteristic of Budd-Chiari syndrome. The portal velocity was reduced (n = 4) or increased (n = 1). The former was considered typical of Budd-Chiari syndrome. In hepatic venocclusive disease the IVC and major hepatic veins showed normal phasic flow; flow velocity in the portal vein was increased. Doppler sonography was found to correlate well with therapeutic results and angiographic findings.