3D-ultrasound diagnosis of portosystemic anastomoses

Abstract

Introduction: The diagnosis of portal hypertension includes the search for portosystemic collateral beds. Only some of these can be explored with real-time US and Doppler -ultrasound, i.e. the umbilical veins, the splenorenal and splenoparietal collaterals, the left gastric vein and the gastroesophageal plexus. Other collateral vessels may occasionally be identified, at the level of the gastric fundus, near the upper pole of the spleen, in the pancreatic region, or in the pericholecystic area. The hemodynamic patterns of the portosystemic collaterals can help in evaluation of hemorrhage risk. Doppler flowmetry is a reliable method for evaluating hemodynamic changes due to administration of different drugs, which proved to be effective in reducing portal hypertension. Color Doppler can help to identify the patients eligible for selective surgery, and can asses the hemodynamic consequences of portosystemic surgical or medical (TIPS) shunts. Doppler flowmetry also plays an important role in the postoperative follow-up of liver transplant. The digital 3D -ultrasound technique makes an immediate spatial reconstruction possible, and data even can be stored and analyzed any time after investigation.