Abstract
This review focuses on ultrasonography (US) to diagnose patients with complications in portal hypertension. Clinicians first use US to evaluate patients with suspected portal hypertension, because US is quick, simple, and radiation free. US is necessary for grading and performing paracentesis for ascites. Doppler US-based detection of reverse splanchnic vein flow or the presence of a spontaneous portosystemic shunt is highly specific in patients with cirrhosis. Since it is important to estimate spleen size in patients with portal hypertension, spleen size is usually measured by US. Spleen volume can be more accurately measured with 3D-US. Estimation of viable residual splenic volume after partial splenic embolization should be limited to cases with total splenic volume less than 1000 ml. Portal vein thrombosis is often detected during the US examination performed when symptoms first appear or during the follow-up. Two-dimensional transthoracic echocardiography is an excellent noninvasive screening test in patients with pulmonary portal hypertension who can undergo it. By measuring the maximum and minimum diastolic blood flow velocities in the renal arteries using renal color Doppler US, the pulsatility index (PI) and resistive index (RI) can be calculated. The PI and RI in cirrhotic patients were significantly higher than those in healthy subjects and patients with chronic hepatitis, and showed a significant positive correlation with the Child–Pugh Score. In conclusion, US is an essential tool for the diagnosis and treatment of patients with portal hypertension.
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Abbreviations
- US:
-
Ultrasonography
- CE-US:
-
Contrast-enhanced US
- PS:
-
Portosystemic shunts
- PVT:
-
Portal vein thrombosis
- PVTT:
-
Portal venous tumor thrombosis
- HVPG:
-
Hepatic venous pressure gradient
- CSPH:
-
Clinically significant portal hypertension
- PoPH:
-
Pulmonary portal hypertension
- HRS:
-
Hepatorenal syndrome
- SBP:
-
Spontaneous bacterial peritonitis
- UVSs:
-
Umbilical vein shunts
- MSs:
-
Mesenteric shunts
- CT:
-
Computed tomography
- SI:
-
Splenic index
- VOCAL:
-
Virtual organ computer-aided analysis
- ICCs:
-
Interclass correlation coefficients
- PSE:
-
Partial splenic embolization
- RHC:
-
Right-sided heart catheterization
- TTE:
-
Transthoracic echocardiography
- RVSP:
-
Right-ventricular systolic pressure
- PASP:
-
Pulmonary artery systolic pressure
- PI:
-
Pulsatility index
- RI:
-
Resistive index
- BUN:
-
Blood urea nitrogen
- Cr:
-
Creatinine
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Acknowledgements
We thank Hitoshi Maruyama, MD, PhD, Department of Gastroenterology, Juntendo University, for advice on writing the manuscript, and Robert E. Brandt, Founder, CEO, and CME, of MedEd Japan, for editing and formatting the manuscript.
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Hidaka, H., Uojima, H. Ultrasonography in the diagnosis of complications in patients with portal hypertension. J Med Ultrasonics 49, 347–358 (2022). https://doi.org/10.1007/s10396-021-01158-3
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DOI: https://doi.org/10.1007/s10396-021-01158-3