- Normal pressure difference between wedged hepatic vein and IVC = 4-8 mm Hg
- Higher pressures suggest portal hypertension
- 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.
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.