A pulsatile portal venous flow pattern is an abnormal form of portal venous flow and can result from both physiological and pathological causes.
In well subjects, mild to marked pulsatility has been described. This is especially so in thin subjects, with a venous pulsatility index of >0.5, inversely correlated to body mass. Decreased pulsatility has been observed when a patient is sitting, during deep inspiration, and in obese subjects. It has been suggested that abdominal pressure is the common factor affecting portal vein pulsatility in these subjects 1.
Pathologically, pulsatile flow in the portal vein have a variety of differentials, as below 2,4. To differentiate between the primary causes, concurrent assessment of the hepatic veins should be performed.
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dilated hepatic veins with decreased or reversed S wave
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dilated hepatic veins with maintained S/D waves relationship
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hepatic veins usually compressed
hereditary hemorrhagic telangiectasia arteriovenous fistulas (rare)
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