Diagnostic Ultrasound - Abdomen and Pelvis

Portal Vein Abnormality
Bland Portal Vein Thrombosis
Bland Portal Vein Thrombosis
(Left) Grayscale ultrasound
shows an echogenic,
chronically thrombosed main
portal vein and adjacent
collateralized flow ſt
indicating cavernous
transformation of the portal
vein. (Right) Color Doppler
ultrasound in the same patient
shows collateralized flow ſt
in the porta hepatis in this
patient with chronic portal
vein thrombosis . Color
Doppler signal is
heterogeneous because portal
vein collaterals are tortuous,
resulting in vessels directed
towards as well as away from
the transducer.
Differential Diagnoses: Liver
Portal Vein Tumor Thrombus
Portal Vein Tumor Thrombus
(Left) Transverse grayscale
ultrasound of the liver in a
patient with hepatocellular
carcinoma shows an expansile
echogenic tumor thrombus in
the main portal vein ſt.
(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.
Pulsatile Portal Vein
Portal Vein Gas
(Left) Spectral Doppler US in a
patient with right heart failure
shows a pulsatile waveform
with flow above and below
ſt baseline in the main portal
vein st. The waveform is
characterized as
predominantly antegrade,
pulsatile, and biphasicbidirectional.
(Right) Oblique
ultrasound of the liver shows
several echogenic foci in the
main portal vein ſt
representing gas bubbles.
Bright echogenic patches st in
the liver parenchyma more
peripherally represent
intraparenchymal portal
venous gas.
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