Sonography of hypertensive portal venous system: correlation with arterial portography

Sixteen patients with portal hypertension and bleeding from gastroesophageal varices were studied prospectively by sonography and arterial portography. Sonography was able to demonstrate anechoic venous structures in characteristic sites in the upper abdomen corresponding with portosystemic collateral veins seen with arterial portography. Of four patients with sonographic visualization of a dilated umbilical vein, three were seen with angiography. Two patients had periportal collateral veins seen with both methods. Of 10 patients with retrograde opacification of the left gastric vein, nine were seen with sonography. Although all 16 patients had endoscopic proof of gastroesophageal varices, only 12 were demonstrated by angiography. Of these 12 patients, 10 had sonographic visualization of varices alone the gastroesophageal junction and lesser curvature of the stomach. One patient with opacification of a gastrorenal communication also had left upper quadrant venous abnormalities at sonography. Sonography is useful in the noninvasive identification of portosystemic collateral vessels in patients with portal hypertension.