Mean Portal Vein Diameter Research Articles

Sonographic Portal Vein Biometry in Apparently Healthy Children in Northeastern Nigeria.

Background:This study aimed at determining the mean portal vein diameter (PVD) based on age, gender, and anthropometric variables.Methods:This was a cross-sectional prospective study carried out among apparently healthy children aged 0–18 years at the radiology department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi, from November 2016 to April 2017. Ethical clearance was obtained from the institutional committee on ethics and the head of radiology department in ATBUTH, Bauchi. Written and informed consent was obtained from all the participants, through their parents or guardians and from the head teachers of their schools before the study. Participants (children) were recruited (voluntarily) from primary and junior secondary schools within the vicinity of the hospital, and from parents who consented for their children to participate in the study. Data analysis was done using SPSS version 22.0. Descriptive statistics (mean, standard deviation, frequency, and percentages) and Pearson product-moment correlation were used for the analysis. Statistical significance was considered at P < 0.05.Results:There were 111 (58.2%) males and 99 (47.14%) females. The individuals were between the ages of <1–18 years with mean age of 8.8 ± 5.8. Participants' mean PVD, chest circumference, and body mass index (BMI) for the males were 6.96 ± 1.86 mm, 0.60 ± 0.08 mm, and 15.73 ± 1.40, respectively, and the mean PVD, chest circumference, and BMI for females were 6.60 ± 1.68 mm, 0.58 ± 0.09 mm, and 15.73 ± 1.42, respectively. A positive relationship was found between PVD and some anthropometric parameters.Conclusion:The mean PVD in this study was 6.85 ± 1.18 mm, and the PVD correlates positively with some anthropometric variables among children in the studied population.

Correlation of portal vein diameter with the presence of oesophageal varices in chronic liver disease: a prospective study

Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(&gt;13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p&lt;0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.

Measurement of Portal Vein Diameter, Peak Systolic Velocity and Pulsatility Index by Ultrasound Doppler Evaluation in Asymptomatic Nepalese Population.

Introduction: Portal vein diameter and Doppler studies give hemodynamic information that can correlate with disease status. Their normal values are not established in Nepalese population. This study aims to establish the normal values of portal vein diameter, PSV and PI in Nepalese population and study their variability with age, gender and ethnicity. Methods: Cross-sectional hospital based study. All adults more than 20 years of age attending ultrasound OPD of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu for general health checkup were included. Patients with liver disease, cardiac disease and ascites were excluded. A single observer took all measurements. Data were entered in a predesigned proforma and analysis was performed with SPSS 21.0. Results: Two hundred patients were included in the study. The mean age was 44.34+12.9 years. The mean portal vein diameter was 10.41+1.18mm. The mean portal vein PSV was 33.35+9.3cm/s and PI was 0.76+0.07. There was a positive correlation of portal vein diameter with age (r=0.345; p&lt;0.001). Also, mean portal vein diameter was significantly higher in males (10.9+0.99mm) than in females (9.9+1.1mm). PSV and PI did not differ with age, gender or ethnicity. Conclusions: Mean portal vein diameter in this study is comparable with previous standards.

Sonographic assessment of the portal vein diameter in apparently healthy adults in a Northern Nigerian population.

Sonography is a valuable tool in the assessment of porto-systemic pathologies. This study aimed at determining the mean portal vein diameter based on age, gender and anthropometric variables. A cross sectional study conducted among 201 apparently healthy adults in Bauchi Metropolis. Participants were recruited from the school of nursing AbubakarTafawa Balewa Teaching Hospital (ATBUTH), Bauchi. Ultrasound machine ALOKA SSD-1000, (IP-1233EV, SN-57324, Japan) with curvilinear transducer with frequency of 3-5MHz was used for a period of four months, (December 2015 to April 2016). Participants' heights were measured while standing against a meter rule with the head in Frankfurts' position and weight measured using a weighing scale. Data analysis was done using SPSS version 22.0. Descriptive statistics (mean, standard deviation), and Pearson's Correlation were used. The mean portal vein diameter was 9.60 ± 1.41mm for both sexes. The mean value for males was 9.71 ± 1.42mm, and 9.35±1.46mm among females. There was a positive correlation correlation between the PV diameter and Body Mass Index (P ≤ 0.01). This study found the mean values of PV diameter in apparently healthy adults in our environment to be 9.60 ± 1.41mm and that PV diameter positively correlates with anthropometric variables.

Portal Vein Diameter by Ultrasonography as a non-Invasive Predictor of Esophageal Varices.

Esophageal varices are one of the most serious consequence of portal hypertension in patients with liver diseases If undetected or left untreated, it can result in massive upper gastrointestinal bleed and can be fatal. Therefore, a timely detection and management of the varices in cirrhotic patient is a must. Several studies have evaluated possible noninvasive markers of esophageal varices to reduce the number of unnecessary endoscopies in patients with cirrhosis but without varices. Endoscopic surveillance of esophageal varices in patients with liver cirrhosis is expensive for the health system and uncomfortable for the patients. Recently, non-invasive ultrasound-based parameters seem to offer valuable information about the status of esophageal varices and thus challenge the need for repetitive endoscopic monitoring. In this study, our aim was to develop a predictive model using an independent risk factor for the presence of varices in the enrolled patients. This is a cross-sectional study. The study analyzed 50 patients with liver diseases from February 2014 to January 2015. All the patients with cirrhosis of either gender except those with hepatocellular carcinoma and previous surgical or medical intervention for portal hypertension were enrolled in the study. Ultrasound of the abdomen was done in all cases to note the portal vein diameter. The varices visualized were graded endoscopically. Data entry was done in SPSS version 20 and statistical analysis was done with Chi Square test. Total 50 patients were enrolled in the test. Varices was present in 47 (96%) of the patients. Small varices were present in 13 (26%) and large varices was present in 34 (68%) of patients. For the patients with small varices, the mean portal vein diameter was 13.23 mm and for those with large varices, the mean portal vein diameter was 16.83 mm. The above results signify that the presence of varices was associated with the mean portal vein diameter of 13.23 mm or more and the result was statistically significant with the p value of 0.024 Measurement of portal vein diameter by ultrasonography can be used as a non-invasive predictive indicator of the development of gastro- esophageal varices in patients with portal hypertension.

Gender Linked Metric Analysis of Portal Vein: A Sonographic Appraisal.

Portal hypertension is one of the most mystifying and disconcerting abdominal ailment. Ultrasonography (USG) is an effective diagnostic tool for its prompt management. Knowledge of normal calibre of portal vein in a local setting is essential as literature reports contrasting values in different regions. It helps in early diagnosis of portal hypertension even before it is clinically manifested thereby assisting clinicians and interventional radiologists in pertinent management. Study was aimed to evaluate the Portal Vein Diameter (PVD) and find its correlation with gender by using USG in North Indian population. A total of 300 healthy adults were included in the study. Portal vein diameter was measured in supine position and normal respiration by grey scale USG. The portal vein diameter was correlated with age and gender statistically using independent Student's t-test and ANOVA. Mean PVD of (9.49±1.03 mm) was observed in the present cross-sectional study. Male showed a significantly higher mean PVD (9.70±1.02 mm) as compared to females (9.10±0.94 mm). Scarcity of information concerning ultrasonographically measured standard portal vein diameter and inconstant values reported in literature necessitates the need for establishing local standard value. In the given subset of population the portal vein diameter was influenced by the gender. The information will be helpful in prompt diagnosis and management of portal hypertension.

Normal main portal vein diameter measured on CT is larger than the widely referenced upper limit of 13mm.

We determined mean main portal vein diameter in healthy patients evaluated with CT, compared this value to the "upper limit of normal" reported previously, and evaluated effects of age, sex, height, and BMI on portal vein diameter. Our cohort of healthy patients underwent abdominal CT as potential renal donors. We excluded patients with evidence of liver or severe cardiac disease. We recorded patients' age, sex, height, weight, and BMI. Patients' main portal vein diameters were measured by fellowship-trained abdominal imagers on non-contrast and post-contrast images in axial and coronal projections at a defined location. A general linear mixed model was used for analysis. 191 patients with 679 main portal vein measurements were included in the analysis. Mean main portal vein diameter was 15.5±1.9mm; this value was significantly different from the upper limit of normal of 13mm commonly referenced in the literature (95% CI: 2.22-2.69mm higher, p<0.0001). Portal vein diameter does not vary significantly when measured on axial vs. coronal images. On average, post-contrast main portal veins were 0.56mm larger compared to non-contrast, (95% CI: 0.40-0.71mm, p<0.0071). Patient height and BMI are positively correlated with MPV diameter. Normal mean portal vein diameter measured on CT was significantly larger (mean 15.5mm) than the accepted upper limit of 13mm. Contrast-enhanced main portal veins are significantly larger (0.56mm) than unenhanced. Sex, height, and BMI significantly affect main portal vein diameter.

Mean Normal Portal Vein Diameter Using Sonography among Clients Coming to Radiology Department of Jimma University Hospital, Southwest Ethiopia.

Mean portal vein diameter is considered as the best indicator for portal hypertension. However, the cutoff point differs from study to study (above 10-15 mm) despite the existence of normal mean portal vein diameter between 10-15 mm in different settings.This implies the existence of limited evidence on normal portal vein diameter for all populations in all countries prior to setting the cutoff points. Therefore, the aim of this study was sonographic assessment of normal mean portal vein diameter among patients referred to The Department of Radiology in Jimma University Hospital. A facility based cross-sectional study was conducted from November to December 2014 at Jimma University Hospital on a total of 195 clients. Data about portal vein diameter for eligible clients were collected by radiologists using Sonography. Data were edited manually, entered and analyzed using SPSS version 16. Data were collected from a total of 195 participants. Among these, 121(62.1%) were males and the median age of the participants was 35 years. The study revealed a normal mean portal vein diameter of 10.6 mm ±1.8 SD with a respirophasic variation of 25.6%. Likewise, the normal mean portal vein diameter seemed to have varied significantly by age and sex. The study revealed a normal mean portal vein diameter ranging below 13 mm. Hence, decisions made in clinical settings should base on these findings. Besides, there is a need for large scale study to determine portal vein diameter variation by age and sex, controlling other confounders.

Portal hypertensive gastropathy in cirrhotics without varices: a case-control study.

Information is lacking on portal hypertensive gastropathy (PHG) in cirrhotics without varices; our aim it is to evaluate whether clinical and sonographic parameters are associated with PHG and may provide information suitable for the management of these patients. After endoscopic selection of 145 cirrhotics without varices, 75 with PHG and 70 without PHG, clinical and sonographic characteristics were assessed. Forty portosystemic shunts were present in 27 patients. The mean Child-Pugh score was 6.3±1.4 and 5.6±0.5 in patients with severe and mild PHG, respectively (P=0.004). The mean portal vein diameter was 10.4±1.7 and 11.6±2.0 mm in cirrhotics without and with PHG, respectively (P=0.0002). A link between the presence of PHG and a more advanced phase of cirrhosis was found. Duplex Doppler sonography was confirmed to be a valuable diagnostic method in monitoring cirrhosis. Management of these patients cannot be performed on the basis of a single diagnostic method, and a multimodal diagnostic approach is required.

Determination of normal portal vein diameter on ultrasound scan among adults in northeastern Nigeria

Background: Despite the safety, affordability, and widespread use of ultrasound (US); there is paucity of literature on ultrasonographic assessment of portal vein (PV) diameter in adult patients in our environment. This study was aimed at determining the mean and range of PV diameter in normal adults in northeastern Nigeria. Patients and Methods: This cross-sectional prospective study was carried out at the University of Maiduguri Teaching Hospital between January and June, 2013. Two hundred and fifty normal adult male and female patients aged 18 years and above underwent abdominal ultrasonography for measurement of their main, right, and left PV diameter in both inspiration and expiration. The relationship between the PV diameter and age was correlated using Pearson's correlation test. While the difference between the two sexes and phases of respiration were compared using Student's t-test. Results: There were 187 (74.8%) males and 63 (25.2%) females aged between 19 and 77 years, mean 43.78 ± 12.97 years. The mean diameter of the main PV was 10.87 mm ± 0.81. The mean diameter of the right and left PVs were 4.35 mm ± 0.52 and 4.12 mm ± 0.52, respectively. The PV diameter correlated with age and respiratory phases (P Conclusion: The mean PV diameter in normal adults has been established in northeastern Nigeria. The diameter correlated with age and showed significant difference between the two sexes and respiratory phases.

Non-invasive parameters for the detection of variceal bleed in patients of liver cirrhosis, an experience of a tertiary care hospital in Pakistan

Objective: Cirrhotic patients commonly undergo screening endoscopy for the existence of esophageal varices. The use of this invasive procedure which is expensive, poorly tolerable and generally not acceptable for the patients is increasing due to increasing number of patients with chronic liver disease and their enriched survival. In this study, our aim is to identify clinical, biochemical, and ultrasonography parameters which might non-invasively predict the presence of esophageal varices and risk of bleeding in patients with liver cirrhosis. Material and Methods: Total 150 Patientsof chronic liver disease admitted in ward-5, JPMC(Sep 2011-Feb 2012) with a complaint of hematemesis or melena were included in the study. Platelet counts of 75,000 to 150,000/μL was defined as grade 1 thrombocytopenia, 50,000 to &lt;75,000/μL as grade II, 25,000 to &lt;50,000/μL as grade III and below 25,000/μL as grade IV. The normal range for the INR is 0.8–1.2. Portal vein size of 1.2 cm or above was taken as dilated. Spleen of &gt;13 cm was considered as enlarged in our study. Results: Out of 72 patients of variceal bleed 69 (46%) were males and 81(54%) were females. Thrombocytopenia was present in 64 (88%) patients with mean platelet count of 85.86/μL (±69.79). Deranged coagulation profile was present in 56 (77%) cases with mean INR of 1.63 (±0.5). Portal vein diameter (PVD) of &gt;1.2 cm was found in 46(63.8%) of patients with mean PVD of 1.22(±0.3023) and splenic size of &gt;13 cm was reported in 54 (75%) cases with mean splenic diameter of 14.5 cm (±2.39). Conclusion: Thrombocytopenia, deranged coagulation profile, large splenic size, and dilated portal vein strongly predict the risk of variceal bleeding. DOI: http://dx.doi.org/10.3126/ajms.v6i1.9624 Asian Journal of Medical Sciences Vol.6(1) 2015 61-66

Portal Vein Diameter in Patients with Liver Cirrhosis and Hepatic Encephalopathy

Purpose: Hepatic encephalopathy (HE) is a common complication encountered in patients with liver cirrhosis. HE is associated with significant morbidity and mortality. HE is not reflected in the current liver transplant allocation system as its severity does not always correlate with the MELD score. A retrospective analysis of patients with cirrhosis who presented for liver transplant evaluation was conducted. Correlation between HE with findings detected on radiographic imaging studies and the patient's clinical profile were sought. Methods: A registry of the patients who were evaluated in the liver transplant clinic in 2009 and 2010 was reviewed. Patients with hepatocelluar carcinoma, ejection fraction less than 60% and patients who had a TIPS (Transjugular Intrahepatic Portosystemic Shunting) procedure or did not complete the evaluation were excluded. Patient's imaging studies were reviewed by an attending radiologist. These findings were correlated with patient's baseline demographics, medical history and their clinical presentation. Statistical analysis was performed and variables found to be significant on univariate analysis (P<0.05) were analyzed by multivariate logistic regression model. Results: 117 patients met inclusion criteria. They were divided into a HE group (n=58) and a control group (n=59) based on whether or not they had clinical evidence of HE. The two groups were comparable in age, sex and MELD scores. Alcohol and HCV were the most common causes of liver cirrhosis. Mean portal vein diameter (PVD) was 12.1 +/- 2.9 mm in the HE group as compared to 14 +/- 3.1 mm in the control group (P=0.001). Univariate analysis found that a smaller portal vein diameter, smaller liver anteroposterior diameter, diuretic use, use of centrally acting medications and liver nodularity had significant correlation with hepatic encephalopathy. This association was confirmed for portal vein diameter, use of diuretics and centrally acting medications in the multivariate analysis. A 1-mm increase in portal vein diameter is associated with a 15% decrease in the odds of encephalopathy (OR 0.85; 95% CI 0.73-0.99). Conclusion: A decrease in PVD was associated with increased risk of HE. Hypothetically, the decreased portal vein size leads to more shunting of blood away for the liver thereby increasing HE risk. Identifying patients with smaller PVD may warrant screening for HE by more advanced psychometric testing, protein restriction and more aggressive control of constipation and other factors that may precipitate encephalopathy.

The Prediction of Liver Disease Status Using a Combination of Sonographic and Doppler-Derived Observations of the Portal Venous System

A novel diagnostic test, named the PREW© score, was formulated to predict the known liver disease status of a purposive sample of 500 patients (304 cases and 196 controls) referred for abdominal sonograms. The score was defined by (P R E)/W, where P = portal vein pressure gradient (mm Hg), R = ratio between the observed mean portal vein diameter in the patient (mm) and the mean diameter in healthy subjects (mm), E = echogenicity of liver parenchyma (ECHO grade scale), and W = hepatic venous waveform (1 = monophasic to 3 = triphasic). Cases with PREW scores &gt;50 were about 480 times more likely than the controls to be diagnosed with cirrhosis/ascites. Cases with PREW scores of 16 to 50 were about 6 to 15 times more likely than the controls to be diagnosed with hepatitis and about 15 to 120 times more likely to be diagnosed with cirrhosis/ascites. It was not possible to clearly discriminate between a diagnosis of hepatitis and cirrhosis/ascites if the PREW score was less than 50. The likelihoods of patients with PREW scores &gt;25 being diagnosed with nonalcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) or gallbladder (GB) disease were not statistically significant. A PREW score greater than 25 identified cases diagnosed with hepatitis/cirrhosis/ascites but eliminated diagnoses of NAFLD/NASH/GB. The clinical implication is that a PREW score &gt;50 may help to facilitate the diagnosis of cirrhosis without confirmation by liver biopsy.

Correlation Between Sonographic Portal Vein Diameter and Flow Velocity With the Clinical Scoring Systems MELD and CTP in Cirrhotic Patients: Is There a Relationship?

Background: Liver cirrhosis is defined as a chronic disease of the liver with destruction of the hepatic parenchymal cells. The aim of the current study was to investigate the correlation between sonographic portal vein diameter (PVD) as well as portal flow velocity (PFV) with the clinical scoring systems; CTP and MELD in cirrhotic patients. Methods: In this cross sectional study, convenience sampling enrolled 108 patients, diagnosed with liver cirrhosis. Blood samples were taken and all patients subsequently underwent Doppler sonography to determine mean portal vein velocity and diameter. Results: All 108 patients (66 males and 42 females) were enrolled in study. The mean age (± SD) was 50.9 ± 17.6 years (range 13 85). The results of the present work revealed weak +ve correlation between MELD and CHILD scores (r = 0.629; P = 0.01). Moreover, the mean PVD showed a little or no +ve correlation with both MELD and CHILD scores (r = 0.216, P = 0.05) and (r = 0.241, P = 0.05) respectively. However, the mean PFV showed no statistical significant relationship with MELD score (P = 0.41). Conclusions: Sonographic portal vein parameters cannot be a substitute for clinical grading and staging of cirrhosis; and we cannot propose it as a single acceptable diagnostic indicator in grading liver cirrhosis with accuracy.

Correlation Between Sonographic Portal Vein Diameter and Flow Velocity With the Clinical Scoring Systems MELD and CTP in Cirrhotic Patients: Is There a Relationship?

Liver cirrhosis is defined as a chronic disease of the liver with destruction of the hepatic parenchymal cells. The aim of the current study was to investigate the correlation between sonographic portal vein diameter (PVD) as well as portal flow velocity (PFV) with the clinical scoring systems; CTP and MELD in cirrhotic patients. In this cross sectional study, convenience sampling enrolled 108 patients, diagnosed with liver cirrhosis. Blood samples were taken and all patients subsequently underwent Doppler sonography to determine mean portal vein velocity and diameter. All 108 patients (66 males and 42 females) were enrolled in study. The mean age (± SD) was 50.9 ± 17.6 years (range 13 - 85). The results of the present work revealed weak +ve correlation between MELD and CHILD scores (r = 0.629; P = 0.01). Moreover, the mean PVD showed a little or no +ve correlation with both MELD and CHILD scores (r = 0.216, P = 0.05) and (r = 0.241, P = 0.05) respectively. However, the mean PFV showed no statistical significant relationship with MELD score (P = 0.41). Sonographic portal vein parameters cannot be a substitute for clinical grading and staging of cirrhosis; and we cannot propose it as a single acceptable diagnostic indicator in grading liver cirrhosis with accuracy.

Paraumbilical collateral veins on MRI as possible protection against portal venous thrombosis in candidates for liver transplantation

We retrospectively evaluate the potential protective influence of patent paraumblical vein (PUV) collaterals against portal vein (PV) thrombosis and reduced PV diameter in candidates for orthotopic liver transplant (OLT) METHODS: Dynamic 3D contrast-enhanced MRI at 1.5T was obtained in 309 patients with cirrhosis without evidence of malignancy. All MR studies were reviewed by one reader for PUV collaterals, PV thrombosis and PV diameter. Statistical analysis was performed by Fisher exact tests; 50 selected studies were reviewed independently by two additional readers to determine interobserver agreement via intraclass correlation coefficient (ICC). Patent PUV was noted in 119 of 309 patients (38.5%). Mean PV diameter was 13.4 +/- 3.0 mm in patients with PUV compared with 11.3 +/- 3.6 mm without PUV (P < 0.01). Main PV thrombosis was present in 13 of 309 patients (4.2%) and significantly more frequent in those without PUV than with PUV (6.3% vs. 0.8%, P < 0.05). ICC indicated almost perfect agreement among three readers for presence of PUV collaterals (ICC = 0.91) and PV thrombosis (ICC = 0.96). Our results suggest that patients with patent PUV appear less likely to develop main PV thrombosis or small PV diameter, suggesting a protective effect of PUV on PV patency.

Duplex Doppler endosonography in the diagnosis of splenic vein, portal vein, and portosystemic shunt thrombosis

Background/Aims: Endoscopic ultrasonography is a promising procedure for imaging mesenteric vascular structures. Methods: Duplex and color Doppler endosonography were used to prospectively evaluate 20 asymptomatic paid volunteers. Subsequently, 11 patients with nondiagnostic transabdominal ultrasound and suspected thrombosis of the splenic and/or portal veins or a portosystemic shunt were evaluated with duplex endosonography. The final diagnosis was based on CT, angiography, and/or surgery or autopsy findings in 9 of 11 patients. Results: In normal volunteers, mesenteric vessel flow velocities and diameters were similar to previously described values. In 10 of the 11 patients with failed transabdominal ultrasound, duplex endosonography was able to provide the correct diagnosis (accuracy of ultrasound 0% versus EUS 91%, p < .001). Mean portal vein diameter was greater in the patient group than in the normal volunteers (18.5 mm versus 10.7 mm, p < .001) and all of the normal volunteers had a portal vein diameter less than 13 mm. No complications were experienced. Conclusion: Duplex endosonography allows visualization of the intra-abdominal vasculature and can be considered when transabdominal ultrasound is nondiagnostic in patients with suspected thrombosis of their splenic vein, portal vein, or portosystemic shunt. EUS is able to identify indirect findings of portal hypertension including portal vein enlargement and venous collaterals. (Gastrointest Endosc 1995;42:19-26.)