Diagnostic Ultrasound - Abdomen and Pelvis

Portal Vein Occlusion
(Left) Color Doppler
ultrasound in patient with
chronic portal vein thrombosis
shows an echogenic
thrombosed main portal vein
ſt and numerous tortuous
collateral veins anterior to
the thrombosed portal vein.
(Right) Pulsed Doppler
ultrasound shows flow within
the collateral vessels is
monophasic and without
respiratory variation
consistent with portal venous
flow within collateral
veins.
Diagnoses: Liver
(Left) Transverse grayscale
ultrasound of the liver in a
cirrhotic patient shows an
expansile echogenic thrombus
ſt in the main portal vein.
(Right) Color Doppler US in the
same patient shows multiple
small feeding vessels ſt in the
tumor thrombus with a dotdash
pattern. Tumor thrombus
in the setting of
hepatocellular carcinoma is
almost always associated with
infiltrative tumor and carries a
poor prognosis.
(Left) Grayscale ultrasound
shows mildly echogenic
thrombus ſt in the main
portal vein. Note shrunken
liver with irregular surface and
parenchymal coarseness,
indicating cirrhosis st. (Right)
Color Doppler ultrasound in
the same patient shows the
thrombus ſt is nonocclusive
with flow seen along the
posterior portion of the main
portal vein . In cases of
nonocclusive portal vein
thrombosis, care should be
taken not to be fooled by
"blooming artifact" on color
Doppler, which can obscure
thrombus visualization.
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