Hepatic vein flow reversal at duplex sonography: a sign of transjugular intrahepatic portosystemic shunt dysfunction.

Abstract

Sonognaphy is an important diagnostic tool in the noninvasive evaluation of hepatic parenchymal disease and of hepatic vasculatune. With the use of duplex and color Doppier sonognaphy, functional hemodynamic information meganding vascular patency, flow direction, and flow patterns can be obtained [1 , 2]. Recently, these techniques have been used to assess transjugulan intrahepatic portosystemic shunts (TIPS), a relatively new, nonsurgical therapy for the management of uncontrollable vaniceal bleeding associated with portal hypertension. Preliminary observations indicate that Doppler sonography is accurate for detecting TIPS occlusion and may be useful for predicting alterations in shunt function on the basis of calculated flow velocities and changes in direction of portal venous flow [3, 4]. We report here a case of abnormal TIPS function revealed by the sonographic observation of reversal in the direction of flow within the right hepatic vein.