Pulsatile portal venous flow

Last revised by Yuranga Weerakkody on 13 Feb 2022

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 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 also 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 has a short differential as below 2,4. To differentiate between the first three causes, which are the more common, a concurrent assessment of the hepatic veins is very useful.

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