Hepatofugal

Last revised by Dr Daniel J Bell on 26 Aug 2021

Hepatofugal or non-forward portal flow (NFPF) is an abnormal flow pattern in which the portal venous flow is from the periphery of the liver towards the porta hepatis and backwards along the portal vein. This phenomenon is not uncommon in patients with liver disease 3.

It is the opposite of hepatopetal.

Hepatofugal flow can be demonstrated on angiography, Doppler ultrasonography, MRI, and/or CT. Doppler ultrasound however tends to be the best modality at quantifying this abnormality.

  • cirrhosis with portal hypertension
    • considered the most common cause of hepatofugal flow in the portal venous system 3
    • usually tends to be continuous reversal rather than pulsatile reversal
    • indicates advanced portal hypertension 
    • cirrhotic patients with hepatofugal flow are thought to have greater hepatic dysfunction, a higher incidence of hepatic encephalopathy, variceal bleeding and higher mortality compared with cirrhotic patients with hepatopetal flow 5
    • it can change back to hepatopetal flow after ingestion of food, which is considered to be due to a postprandial increase in splanchnic venous flow and portal venous flow, this phenomenon however may be blunted in patients with cirrhosis 3
  • Budd-Chiari syndrome
  • tricuspid regurgitation: tends to have reversed pulsatile flow (RPF) in portal vein.
  • arterioportal fistula in liver
  • post liver transplantation 7

The term hepatofugal derives from the Ancient Greek 'hepar' meaning 'liver' and Latin 'fugare' meaning 'to flee' referring to the direction of flow away from the liver. 

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Cases and figures

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