The Clinical Value of Color Doppler Ultrasound for Prehepatic Portal Hypertension_West China Medical Journal

Authors：

 TangShanhong ¹ , LiangYan ² ,  ZengWeizheng ¹ , ZhouXiaolei ¹ , LiHongyong ¹ , DengDan ² , JiangMingde ¹

1. Department of Gastroenterology;Chengdu Military General Hospital, Chengdu, Sichuan 610083, P. R. China;
2. Department of Ultrasound;Chengdu Military General Hospital, Chengdu, Sichuan 610083, P. R. China;

Corresponding?author：

ZengWeizheng, Email: zengweizheng@163.com

Keywords：

Prehepatic portal hypertension; Color Doppler ultrasound; Artery-portal vein fistula; Splenic vein thrombosis

DOI：

10.7507/1002-0179.201600423

Video：

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Objective To evaluate the clinical value of color Doppler ultrasound in diagnosing prehepatic portal hypertension. Methods A retrospective analysis was performed to analyze the results of color Doppler ultrasonography in 9 patients with prehepatic portal hypertension diagnosed between June 2012 and January 2015, including vessel diameter, shape, nature and direction of blood flow, and fistula blood flow spectrum. Results Among the 9 patients, the color Doppler ultrasound found 3 patients with regional portal widened, increased and faster blood flow with the emergence of low-impedance spectrum artery, splenic vein widened with returning blocked and flocculent substance within the splenic vein lumen, irregular or streak-shaped low weak echo during splenic vein reduction, and unstable or weakened blood flow velocity. Two patients were confirmed with splenic vein thrombosis by ultrasound and other imaging methods with significantly reduced blood in splenic vein. For the other four patients with regional portal hypertension, obvious abnormalities in portal system were not detected by color Doppler ultrasound, but they were checked with other methods. The ultrasound positive diagnosis of the 9 patients was 5, with 4 missed. Conclusion The color Doppler ultrasound has some values in screening, diagnosis and follow-up of prehepatic portal hypertension, but it can also be influenced by many factors with a high missed diagnosis rate. Carefully observing the portal system lumen structure, internal echo and blood flow combined with other imaging studies, and emphasizing clinical history of the patients can further improve diagnostic accuracy.

Citation： TangShanhong, LiangYan, ZengWeizheng, ZhouXiaolei, LiHongyong, DengDan, JiangMingde. The Clinical Value of Color Doppler Ultrasound for Prehepatic Portal Hypertension. West China Medical Journal, 2016, 31(9): 1554-1557. doi: 10.7507/1002-0179.201600423 Copy

1.	Loftus JP, Nagorney DM, Ilstrup D, et al. Sinistral portal hypertension. Splenectomy or expectant management[J]. Ann Surg, 1993, 217(1):35-40.
2.	Hii HP, Wu ZH, Yeh ML, et al. Successful coil embolization of an unusual aorto-superior mesenteric vein fistula[J]. J Vasc Surg, 2009, 49(5):1310-1312.
3.	Gabriel S, Maroney TP, Ringe BH. Hepatic artery-portal vein fistula formation after percutaneous liver biopsy in a living liver donor[J]. Transplant Proc, 2007, 39(5):1707-1709.
4.	Wo;?niak W, Mlosek RK, Mi?ek T, et al. Splenic arteriovenous fistula--late complications of splenectomy[J]. Acta Gastroenterol Belg, 2011, 74(3):465-467.
5.	湯善宏, 曾維政, 何乾文, 等. 胰腺炎后區域性門靜脈高壓1例[J]. 西南國防醫藥, 2015, 25(8):928.
6.	湯善宏, 何煊, 王釗, 等. 部分脾動脈栓塞治療慢性胰腺炎相關脾靜脈血栓致區域性門靜脈高壓1例報告[J]. 臨床肝膽病雜志, 2015, 31(5):771-772.
7.	Tang SH, Zeng WZ, He QW, et al. Repeated pancreatitis-induced splenic vein thrombosis leads to intractable gastric variceal bleeding:a case report and review[J]. World J Clin Cases, 2015, 3(10):920-925.
8.	湯善宏, 何卿瑋, 何乾文, 等. 胰腺膿腫壓迫脾靜脈致區域性門靜脈高壓1例報告[J]. 臨床肝膽病雜志, 2015, 31(5):773-774.
9.	湯善宏, 秦建平, 蔣明德, 等. 動脈-門靜脈系統異常分流致門靜脈高壓診斷與治療進展[J]. 中華肝臟病雜志, 2015, 23(6):86-88.
10.	湯善宏, 楊德會, 曾維政, 等. 外傷后腸系膜上動靜脈瘺致區域性門靜脈高壓一例[J]. 中華消化雜志, 2015, 35(10):709-712.
11.	Qin J, Tang S, Jiang M, et al. Portal hypertension caused by right common iliac artery-superior mesenteric vein fistula[J]. Jpn J Radiol, 2015, 33(5):291-294.
12.	湯善宏, 王釗, 龐玉玲, 等. 斷流胃冠狀靜脈治療胃底靜脈曲張破裂出血都對嗎?談區域性門靜脈高壓發病原因及臨床診治[J]. 醫學爭鳴, 2016, 5(7):23-27.
13.	Sachdeva R, Yapor M, Schwersenz A, et al. Massive variceal bleeding caused by a hepatic artery-portal vein fistula:a manifestation of hepatocellular carcinoma in a 12-year-old[J]. J Pediatr Gastroenterol Nutr, 1993, 16(4):468-471.
14.	Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis:a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding[J]. HPB (Oxford), 2011, 13(12):839-845.
15.	K?klü S, Coban S, Yüksel O, et al. Left-sided portal hypertension[J]. Dig Dis Sci, 2007, 52(5):1141-1149.
16.	Saugel B, Gaa J, Phillip V, et al. Splenic artery embolization in a Woman with bleeding gastric varices and splenic vein thrombosis:a case report[J]. J Med Case Rep, 2010, 4:247.
17.	Luo X, Nie L, Wang Z, et al. Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertension complicated by gastrointestinal bleeding[J]. Cardiovasc Intervent Radiol, 2014, 37(1):108-113.
18.	湯善宏, 曾維政, 陳虹彬, 等. 區域性門靜脈高壓致胃底靜脈曲張出血內鏡下組織膠注射療效分析[J]. 臨床肝膽病雜志, 2015, 31(8):1283-1286.

1. Loftus JP, Nagorney DM, Ilstrup D, et al. Sinistral portal hypertension. Splenectomy or expectant management[J]. Ann Surg, 1993, 217(1):35-40.
2. Hii HP, Wu ZH, Yeh ML, et al. Successful coil embolization of an unusual aorto-superior mesenteric vein fistula[J]. J Vasc Surg, 2009, 49(5):1310-1312.
3. Gabriel S, Maroney TP, Ringe BH. Hepatic artery-portal vein fistula formation after percutaneous liver biopsy in a living liver donor[J]. Transplant Proc, 2007, 39(5):1707-1709.
4. Wo;?niak W, Mlosek RK, Mi?ek T, et al. Splenic arteriovenous fistula--late complications of splenectomy[J]. Acta Gastroenterol Belg, 2011, 74(3):465-467.
5. 湯善宏, 曾維政, 何乾文, 等. 胰腺炎后區域性門靜脈高壓1例[J]. 西南國防醫藥, 2015, 25(8):928.
6. 湯善宏, 何煊, 王釗, 等. 部分脾動脈栓塞治療慢性胰腺炎相關脾靜脈血栓致區域性門靜脈高壓1例報告[J]. 臨床肝膽病雜志, 2015, 31(5):771-772.
7. Tang SH, Zeng WZ, He QW, et al. Repeated pancreatitis-induced splenic vein thrombosis leads to intractable gastric variceal bleeding:a case report and review[J]. World J Clin Cases, 2015, 3(10):920-925.
8. 湯善宏, 何卿瑋, 何乾文, 等. 胰腺膿腫壓迫脾靜脈致區域性門靜脈高壓1例報告[J]. 臨床肝膽病雜志, 2015, 31(5):773-774.
9. 湯善宏, 秦建平, 蔣明德, 等. 動脈-門靜脈系統異常分流致門靜脈高壓診斷與治療進展[J]. 中華肝臟病雜志, 2015, 23(6):86-88.
10. 湯善宏, 楊德會, 曾維政, 等. 外傷后腸系膜上動靜脈瘺致區域性門靜脈高壓一例[J]. 中華消化雜志, 2015, 35(10):709-712.
11. Qin J, Tang S, Jiang M, et al. Portal hypertension caused by right common iliac artery-superior mesenteric vein fistula[J]. Jpn J Radiol, 2015, 33(5):291-294.
12. 湯善宏, 王釗, 龐玉玲, 等. 斷流胃冠狀靜脈治療胃底靜脈曲張破裂出血都對嗎?談區域性門靜脈高壓發病原因及臨床診治[J]. 醫學爭鳴, 2016, 5(7):23-27.
13. Sachdeva R, Yapor M, Schwersenz A, et al. Massive variceal bleeding caused by a hepatic artery-portal vein fistula:a manifestation of hepatocellular carcinoma in a 12-year-old[J]. J Pediatr Gastroenterol Nutr, 1993, 16(4):468-471.
14. Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis:a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding[J]. HPB (Oxford), 2011, 13(12):839-845.
15. K?klü S, Coban S, Yüksel O, et al. Left-sided portal hypertension[J]. Dig Dis Sci, 2007, 52(5):1141-1149.
16. Saugel B, Gaa J, Phillip V, et al. Splenic artery embolization in a Woman with bleeding gastric varices and splenic vein thrombosis:a case report[J]. J Med Case Rep, 2010, 4:247.
17. Luo X, Nie L, Wang Z, et al. Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertension complicated by gastrointestinal bleeding[J]. Cardiovasc Intervent Radiol, 2014, 37(1):108-113.
18. 湯善宏, 曾維政, 陳虹彬, 等. 區域性門靜脈高壓致胃底靜脈曲張出血內鏡下組織膠注射療效分析[J]. 臨床肝膽病雜志, 2015, 31(8):1283-1286.

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