Duplex Doppler endosonography in the diagnosis of splenic vein, portal vein, and portosystemic shunt thrombosis.
OBJECTIVE
Endoscopic ultrasonography is a promising procedure for imaging mesenteric vascular structures.


METHODS
Duplex and color Doppler endosonography were used to prospectively evaluate 20 asymptomatic paid volunteers. Subsequently, 11 patients with nondiagnostic transabdominal ultrasound and suspected thrombosis of the splenic and/or portal veins or a portosystemic shunt were evaluated with duplex endosonography. The final diagnosis was based on CT, angiography, and/or surgery or autopsy findings in 9 of 11 patients.


RESULTS
In normal volunteers, mesenteric vessel flow velocities and diameters were similar to previously described values. In 10 of the 11 patients with failed transabdominal ultrasound, duplex endosonography was able to provide the correct diagnosis (accuracy of ultrasound 0% versus EUS 91%, p < .001). Mean portal vein diameter was greater in the patient group than in the normal volunteers (18.5 mm versus 10.7 mm, p < .001) and all of the normal volunteers had a portal vein diameter less than 13 mm. No complications were experienced.


CONCLUSIONS
Duplex endosonography allows visualization of the intra-abdominal vasculature and can be considered when transabdominal ultrasound is nondiagnostic in patients with suspected thrombosis of their splenic vein, portal vein, or portosystemic shunt. EUS is able to identify indirect findings of portal hypertension including portal vein enlargement and venous collaterals.
Wiersema
M J
MJ
Department of Medicine, St. Vincent Hospital and Health Care Center, Indianapolis, Indiana, USA.
Chak
A
A
Kopecky
K K
KK
Wiersema
L M
LM
D000328:Adult; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D013162:Splenic Vein / Q000000981:diagnostic imaging*; D013164:Splenorenal Shunt, Surgical; D013927:Thrombosis / Q000000981:diagnostic imaging*; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional