‫بسم ا الرحمن‬‫الرحيم‬
Role of color Doppler in evaluation of portal hypertension By Dr. HATEM EL-AZIZI ASS. PROF. OF RADIODIAGNOSI...
What is portal hypertension
Portal hypertension Defined as  elevation of pressure above 10 mmHg  Difference in pressure between PV & IVC ...
Portal hypertensionDefinition Acute or chronic hepatocellular disease can block the flow of blood throughout the liver,...
Portal hypertension causes  pre hepatic  Hepatic  Post hepatic
? what to examin
Portal hypertension Portal vein Hepatic vines IVC Splenic vein Hepatic artery Splenic artery Superior mesen...
!! Search & analysis
Portal hypertension Flow pattern velocity Doppler indices waveform
Flow pattern
Portal hypertension Flow pattern  Normal  Hepatopedal Abnormal  hepatopedal  Hepatofugal  ...
Basics of Doppler
Basics of DopplerThe sound frequency from an approaching source is higher than from one re...
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler Re dB loo ...
Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular struct...
Basics of Doppler Re dB loo ...
Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular struct...
Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular struct...
Basics of Doppler Re dB ...
Basics of Doppler Re dB ...
Basics of Doppler Re dB ...
Basics of Doppler Re dB ...
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Basics of Doppler
Portal hypertension Flow pattern  Normal  Hepatopedal Abnormal  hepatopedal  Hepatofugal  ...
Portal hypertension
Portal hypertension
Portal hypertension
Portal hypertension
Portal hypertension
Portal hypertension
Doppler indices
Portal hypertension Portal vein velocity  Normal  20.2 -33.3 cm/sec  Cirrhosis  11.0 cm/sec...
Portal hypertension Congestion index  ratio between cross section area and flow velocity  Increase in PH  Norm...
Portal hypertension Splenic arterial RI  0.60 measured at splenic hilum  Increased in PH
Portal hypertension Liver vascular index  Ratio between portal venous velocity & hepatic artery PI  Cut-off ...
Waveform analysis
Portal vein Continuous low velocity phasic signal; phasic means that the velocity increases and decreases with respira...
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Portal vein
Hepatic Artery Low resistance waveform; forward flow in diastole above baseline NOTE: The hepatic artery and portal ve...
Hepatic Artery
Hepatic Artery
Hepatic Venous System Multi-phasic pulsatile flow pattern secondary to proximity of the right atrium with flow above an...
Hepatic Venous System
Hepatic Venous System
Hepatic Venous System
Hepatic Venous System
Hepatic Venous System
Hepatic Venous System
Inferior Vena Cava Continuous waveform with respiratory variations; become more pulsatile as it empties into the right ...
Thank You
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Portal ht

Published on: Mar 4, 2016
Published in: Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Portal ht

  • 1. ‫بسم ا الرحمن‬‫الرحيم‬
  • 2. Role of color Doppler in evaluation of portal hypertension By Dr. HATEM EL-AZIZI ASS. PROF. OF RADIODIAGNOSIS CAIRO UNIVERSTIY
  • 3. What is portal hypertension
  • 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. 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. Portal hypertension causes  pre hepatic  Hepatic  Post hepatic
  • 7. ? what to examin
  • 8. Portal hypertension Portal vein Hepatic vines IVC Splenic vein Hepatic artery Splenic artery Superior mesenteric artery
  • 9. !! Search & analysis
  • 10. Portal hypertension Flow pattern velocity Doppler indices waveform
  • 11. Flow pattern
  • 12. Portal hypertension Flow pattern  Normal  Hepatopedal Abnormal  hepatopedal  Hepatofugal  Bidirectional  Static
  • 13. Basics of Doppler
  • 14. Basics of DopplerThe sound frequency from an approaching source is higher than from one receding
  • 15. Basics of Doppler
  • 16. Basics of Doppler
  • 17. Basics of Doppler
  • 18. Basics of Doppler
  • 19. Basics of Doppler
  • 20. Basics of Doppler
  • 21. Basics of Doppler
  • 22. Basics of Doppler
  • 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. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell
  • 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. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell
  • 27. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell
  • 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. 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. 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. 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. Basics of Doppler
  • 33. Basics of Doppler
  • 34. Basics of Doppler
  • 35. Basics of Doppler
  • 36. Basics of Doppler
  • 37. Basics of Doppler
  • 38. Portal hypertension Flow pattern  Normal  Hepatopedal Abnormal  hepatopedal  Hepatofugal  Bidirectional  Static
  • 39. Portal hypertension
  • 40. Portal hypertension
  • 41. Portal hypertension
  • 42. Portal hypertension
  • 43. Portal hypertension
  • 44. Portal hypertension
  • 45. Doppler indices
  • 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. 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. Portal hypertension Splenic arterial RI  0.60 measured at splenic hilum  Increased in PH
  • 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. Waveform analysis
  • 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. Portal vein
  • 53. Portal vein
  • 54. Portal vein
  • 55. Portal vein
  • 56. Portal vein
  • 57. Portal vein
  • 58. Portal vein
  • 59. Portal vein
  • 60. Portal vein
  • 61. Portal vein
  • 62. Portal vein
  • 63. Portal vein
  • 64. Portal vein
  • 65. Portal vein
  • 66. Portal vein
  • 67. Portal vein
  • 68. Portal vein
  • 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. Hepatic Artery
  • 71. Hepatic Artery
  • 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. Hepatic Venous System
  • 74. Hepatic Venous System
  • 75. Hepatic Venous System
  • 76. Hepatic Venous System
  • 77. Hepatic Venous System
  • 78. Hepatic Venous System
  • 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. Thank You

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