Pulsatile portal venous flow pattern can result from both physiological and pathological causes.
Usually, mild pulsatility or in rare situations even marked pulsatility has been described, particularly in thin subjects with a venous pulsatility index of >0.5 with an inverse correlation to body mass. Decreased pulsatility has been observed when the patient is sitting and 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.
In pathological situations, pulsatile flow in the portal vein has been found in patients with a few conditions that have been listed below 2,4. To differentiate among the first three causes, which are the more common, the cojoined assessment of the hepatic veins is very useful.
- dilated hepatic veins with decreased or reversed S wave
right heart failure
- dilated hepatic veins with maintained S/D waves relationship
- hepatic veins usually compressed
- hereditary haemorrhagic telangiectasia arteriovenous fistulas (rare)
- 1. Görg C, Riera-knorrenschild J, Dietrich J. Pictorial review: Colour Doppler ultrasound flow patterns in the portal venous system. Br J Radiol. 2002;75 (899): 919-29. Br J Radiol (citation) - Pubmed citation
- 2. Abu-yousef MM, Milam SG, Farner RM. Pulsatile portal vein flow: a sign of tricuspid regurgitation on duplex Doppler sonography. AJR Am J Roentgenol. 1990;155 (4): 785-8. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Wachsberg RH, Needleman L, Wilson DJ. Portal vein pulsatility in normal and cirrhotic adults without cardiac disease. J Clin Ultrasound. 1995;23 (1): 3-15. Pubmed citation
- 4. McNaughton DA, Abu-Yousef MM. Doppler US of the liver made simple. Radiographics : a review publication of the Radiological Society of North America, Inc. 31 (1): 161-88. doi:10.1148/rg.311105093 - Pubmed