Diagnostic ultrasound ( PDFDrive )

CHAPTER 4 The Liver 97
A
B
C
D
E
F
FIG. 4.31 Portal Hypertension. (A) Sagittal image of recanalized paraumbilical vein in patient with gross ascites. (B) Sagittal image shows
enlarged coronary vein running cephalad from the splenic vein (SV). (C) Gray-scale image and (D) color Doppler image show extensive varices in
the distribution of the coronary vein. (E) Gray-scale image and (F) color Doppler image show splenic hilar varices.
(>1.3 cm) in portal hypertension, 81 with the development of
portosystemic shunts, the portal vein caliber will decrease. 82 Five
major sites of portosystemic venous collaterals are visualized
by ultrasound 83-85 (see Fig. 4.30).
• Gastroesophageal junction: Between the coronary and short
gastric veins and the systemic esophageal veins. hese varices
are of particular importance because they may lead to lifethreatening
or fatal hemorrhage. Dilation of the coronary
vein (>0.7 cm) is associated with severe portal hypertension
(portohepatic gradient >10 mm Hg) 82 (Fig. 4.31C and D).
• Paraumbilical vein: Runs in the falciform ligament and
connects the let portal vein to the systemic epigastric veins