Diagnostic Ultrasound - Abdomen and Pelvis

Transjugular Intrahepatic Portosystemic Shunt (TIPS)
(Left) Grayscale ultrasound of
the liver shows a TIPS
extending from the main
portal vein st to the right
hepatic vein near its
confluence with the IVC. The
proximal end of this patient's
shunt is slightly more central
than typically seen but was
related to a shunt revision.
(Right) Color Doppler image of
a TIPS ſt shows appropriate
direction of flow towards the
IVC.
Diagnoses: Liver
(Left) In TIPS evaluation with
color Doppler, the curvature of
the stent in relation to the
transducer may result in
apparent flow towards the
transducer (red) ſt before the
bend , and flow away from
the transducer (blue) distally
. Flow within the TIPS
however is uniformly directed
towards the IVC. (Right)
Longitudinal color Doppler
ultrasound in a patient with a
TIPS shows appropriate
velocity of 115 cm/sec and
gentle undulation of the
waveform st.
(Left) Grayscale ultrasound of
the liver shows the proximal
portion of a TIPS beginning
at the distal portion of the
main portal vein ſt. Note
large amount of ascites that
suggests developing st shunt
malfunction. (Right)
Longitudinal spectral Doppler
ultrasound in the same patient
demonstrates borderline
elevated velocity (188 cm/s)
and loss of pulsatility st in the
mid portion of shunt ſt,
suggestive of developing shunt
stenosis.
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