Utility and limitations of splanchnic venous ultrasonography in diagnosis of portal hypertension.
The splanchnic venous system was examined by real-time ultrasonography in 46 patients with cirrhosis and documented portal hypertension and in 32 healthy subjects. Patients with portal hypertension had increased diameter of the splanchnic (portal, splenic, and superior mesenteric) veins (76% of patients), attenuation of the normal inspiratory increase in vein size (59%), and demonstrable portasystemic collateral vessels (umbilical or coronary veins or spontaneous splenorenal shunt) (44%). Splanchnic venous dimensions were significantly increased and changed less with respiration in patients with demonstrable portasystemic collaterals as compared to patients without these vessels. Portal pressure correlated only mildly with portal vein diameter (r = 0.30, p less than 0.05). Ultrasound abnormalities are present in a majority of patients with intrahepatic portal hypertension. However, because increased venous diameter and attenuated change in diameter with respiration are less frequent in patients lacking demonstrable portasystemic collaterals, the sensitivity of the test is least in those patients in whom its specificity is also limited.
D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D008103:Liver Cirrhosis / Q000175:diagnosis; D008642:Mesenteric Veins / Q000033:anatomy & histology; D011169:Portal Vein / Q000033:anatomy & histology; D011446:Prospective Studies; D013152:Splanchnic Circulation; D013162:Splenic Vein / Q000033:anatomy & histology; D014463:Ultrasonography; D014471:Umbilical Veins / Q000033:anatomy & histology