Abstract
Pulsed and color Doppler US demonstrated regular blood fl ow with a forward fl ow direction in the IVC (Fig. 1a). Although the MHV retained blood fl ow with a forward direction, the RHV did not reveal any blood fl ow signal (Fig. 1b). Detailed evaluation of blood fl ow in the LHV was prevented by a cardiac motion artifact. Blood fl ow in both the intrahepatic portal vein and the portal trunk had a to-and-fro or reversed fl ow appearance (Fig. 1c), and that in the splenic vein was a continuous reverse fl ow, as the patient had a large splenorenal shunt. These US fi ndings strongly suggested hepatic vein obstruction, that is, Budd– Chiari syndrome, with development of a portosystemic collateral vessel.
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