Portal hypertension

  • Normal pressure difference between wedged hepatic vein and IVC = 4-8 mm Hg
  • Higher pressures suggest portal hypertension
  • Ascites
  • Distended mesenteric veins
  • Distended walls of gall bladder
  • Stomach and small bowel are edematous
  • Splenomegaly not always present
  • Portal vein diameter > 15 mm suggests hypertension but a normal diameter does not rule out hypertension
  • Porto-systemic collaterals suggest portal venous hypertension. Common sites: splenogastric, gastroesophageal, splenorenal, recanalised paraumbilical veins
  • US: reliable. Confirms size, potency, flow direction in main portal vein. PSV <10 cm/s is abnormal. Progression from hepatopetal to stationary/oscillatory to hepatofugal flow. 
  • CT and MRI: gives a good overview of all the findings. Better visualization of edema of gastric wall and small bowel wall. 
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Bolondi, L., et al. “Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration.” Radiology 142.1 (1982): 167-172.

Patriquin, H. M. P. M., et al. “Duplex Doppler examination in portal hypertension: technique and anatomy.” American Journal of Roentgenology 149.1 (1987): 71-76.