Portal ht

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Portal ht

  1. 1. ‫بسم ا الرحمن‬‫الرحيم‬
  2. 2. Role of color Doppler in evaluation of portal hypertension By Dr. HATEM EL-AZIZI ASS. PROF. OF RADIODIAGNOSIS CAIRO UNIVERSTIY
  3. 3. What is portal hypertension
  4. 4. Portal hypertension Defined as  elevation of pressure above 10 mmHg  Difference in pressure between PV & IVC more than 5 mmHg Complication of portal hypertension occurs above 12mmHg
  5. 5. Portal hypertensionDefinition Acute or chronic hepatocellular disease can block the flow of blood throughout the liver, causing it to back up into the hepatic portal circulation. This causes the blood pressure in the hepatic circulation to increase (portal hypertension). In an effort to relieve the pressure, collateral veins are formed that connect to the systemic veins. This is known as varicose veins and occurs most frequently in the area of the esophagus, stomach, and rectum. Rupture of these veins may cause massive bleeding that may result in death.
  6. 6. Portal hypertension causes  pre hepatic  Hepatic  Post hepatic
  7. 7. ? what to examin
  8. 8. Portal hypertension Portal vein Hepatic vines IVC Splenic vein Hepatic artery Splenic artery Superior mesenteric artery
  9. 9. !! Search & analysis
  10. 10. Portal hypertension Flow pattern velocity Doppler indices waveform
  11. 11. Flow pattern
  12. 12. Portal hypertension Flow pattern  Normal  Hepatopedal Abnormal  hepatopedal  Hepatofugal  Bidirectional  Static
  13. 13. Basics of Doppler
  14. 14. Basics of DopplerThe sound frequency from an approaching source is higher than from one receding
  15. 15. Basics of Doppler
  16. 16. Basics of Doppler
  17. 17. Basics of Doppler
  18. 18. Basics of Doppler
  19. 19. Basics of Doppler
  20. 20. Basics of Doppler
  21. 21. Basics of Doppler
  22. 22. Basics of Doppler
  23. 23. Basics of Doppler Re dB loo d Ce lls No rm al R ed Blo o dC ells Ce Ab llul no ar rm stru ctu al R re ed of r Bl o ed od bloRe od C ells d cel blo l od c ell as vi
  24. 24. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell
  25. 25. Basics of Doppler Re dB loo dC ells No rm al R ed Blo o dC ells Ce llula r stru ctu re o f re db loo Re dc d bl ell
  26. 26. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell
  27. 27. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell
  28. 28. Basics of Doppler Re dB loo d Ce lls No rm Re al R dB ed Blo loo o dC dC ells ells Norm Ce al R llul ed ar stru Blo ctu od re Ce of r lls ed blo Re od db cel lo o l dc ell Ce as llul vie ar we stru d fr ctu om re the of r s id ed e b lo Re od db cel l l
  29. 29. Basics of Doppler Re dB loo d Ce lls No rm Re al R dB ed Blo loo o dC dC ells ells Norm Ce al R llul ed ar stru Blo ctu od re Ce of r lls ed blo Re od db cel lo o l dc ell Ce as llul vie ar we stru d fr ctu om re the of r s id ed e b lo Re od db cel l l
  30. 30. Basics of Doppler Re dB loo d Ce lls No rm Re al R dB ed Blo loo o dC dC ells ells Norm Ce al R llul ed ar stru Blo ctu od re Ce of r lls ed blo Re od db cel lo o l dc ell Ce as llul vie ar we stru d fr ctu om re the of r s id ed e b lo Re od db cel l l
  31. 31. Basics of Doppler Re dB loo d Ce lls No rm Re al R dB ed Blo loo o dC dC ells ells Norm Ce al R llul ed ar stru Blo ctu od re Ce of r lls ed blo Re od db cel lo o l dc ell Ce as llul vie ar we stru d fr ctu om re the of r s id ed e b lo Re od db cel l l
  32. 32. Basics of Doppler
  33. 33. Basics of Doppler
  34. 34. Basics of Doppler
  35. 35. Basics of Doppler
  36. 36. Basics of Doppler
  37. 37. Basics of Doppler
  38. 38. Portal hypertension Flow pattern  Normal  Hepatopedal Abnormal  hepatopedal  Hepatofugal  Bidirectional  Static
  39. 39. Portal hypertension
  40. 40. Portal hypertension
  41. 41. Portal hypertension
  42. 42. Portal hypertension
  43. 43. Portal hypertension
  44. 44. Portal hypertension
  45. 45. Doppler indices
  46. 46. Portal hypertension Portal vein velocity  Normal  20.2 -33.3 cm/sec  Cirrhosis  11.0 cm/sec  Portal hypertension  15.9 cm/sec
  47. 47. Portal hypertension Congestion index  ratio between cross section area and flow velocity  Increase in PH  Normal  0.06  Oesophageal varices  0.145  Cirrhosis  0.11
  48. 48. Portal hypertension Splenic arterial RI  0.60 measured at splenic hilum  Increased in PH
  49. 49. Portal hypertension Liver vascular index  Ratio between portal venous velocity & hepatic artery PI  Cut-off of liver vascular index 12 cm/sec Liver vascular index  Normal  8.7+2.1  Significantly higher in patient with PH 17.2+4.3
  50. 50. Waveform analysis
  51. 51. Portal vein Continuous low velocity phasic signal; phasic means that the velocity increases and decreases with respirations giving the signal a smooth wavelike appearance Normal flow is termed hepatopedal (toward the liver( Reversed flow is hepatofugal.
  52. 52. Portal vein
  53. 53. Portal vein
  54. 54. Portal vein
  55. 55. Portal vein
  56. 56. Portal vein
  57. 57. Portal vein
  58. 58. Portal vein
  59. 59. Portal vein
  60. 60. Portal vein
  61. 61. Portal vein
  62. 62. Portal vein
  63. 63. Portal vein
  64. 64. Portal vein
  65. 65. Portal vein
  66. 66. Portal vein
  67. 67. Portal vein
  68. 68. Portal vein
  69. 69. Hepatic Artery Low resistance waveform; forward flow in diastole above baseline NOTE: The hepatic artery and portal vein flow should be in the same direction as the hepatic artery runs parallel with the portal vein.
  70. 70. Hepatic Artery
  71. 71. Hepatic Artery
  72. 72. Hepatic Venous System Multi-phasic pulsatile flow pattern secondary to proximity of the right atrium with flow above and below the baseline Right sided heart failure may cause the hepatic veins to become pulsatile and dilated. Increased intrahepatic pressure or venous obstruction demonstrates a more continuous or monophonic signal
  73. 73. Hepatic Venous System
  74. 74. Hepatic Venous System
  75. 75. Hepatic Venous System
  76. 76. Hepatic Venous System
  77. 77. Hepatic Venous System
  78. 78. Hepatic Venous System
  79. 79. Inferior Vena Cava Continuous waveform with respiratory variations; become more pulsatile as it empties into the right atrium. Best imaged with a slight cranial- caudal sweep in the longitudinal plane with the patient in deep inspiration Thrombosis can cause the IVC waveform to appear monophasic with high velocities.
  80. 80. Thank You

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