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Portal HTNFrom: Rich Dempsey RDMS/RVT (ridem@msn.com)Mon Sep 13 20:30:57 1999
Perhaps a bit "off topic", as both patients were male, however it is concievable that similar findings might be encountered with acute fatty liver of pregnancy,cardiac and/or liver disease complicating pregnancy, etc... Did 2 abdominal US’s today for portal HTN. Both had ascites, and bilateral pleural effusions. The first patient had a history of prior AO valve replacement 12 years ago after a bout with endocarditis, and was being worked up for portal HTN due to Hepatitis C. The second patient ,had a vague prior medical history due to his recent hospital admission. Both patients had dramatic biphasic portal vein flow ( high amplitude above and below baseline at 30 cm/sec). The first patient also had high resistance Hepatic artery flow ( absence of diastolic flow), I was unable to get a Hepatic artery flow in the 2nd patient due to his respiration rate, and other technical factors. Both patients had livers measuring greater than 18 cm, and portal vein diameter was greater than 16 mm in both patients, measured transversely. No varices were seen in either patient( at the porta, and the flow in the splenic vein was biphasic in the both patients, but predominately hepatopedal. Both patients had very dilated Hepatic veins, with a very pulsatile flow ("rick-rack flow"). This is an urban county hospital, both patients had a history of ETOH abuse. Yet the work up was presumptive of ascites/portal HTN due to liver disease. Any one have opinions ,or further information on post-sinusoidal obstruction due to elevated central venous pressure, associated with cardiac disease? Both studies were diagnostic, but I felt (afterwards) I could have gotten more information had I done pulsatility indices on the Hepatic artery. Suggestions?
-- Rich Dempsey RDMS/RVT
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