Case contributed by Dr Bruno Di Muzio


Previous history of heavy alcoholism.

Patient Data

Age: 70 years
Gender: Male

US Abdomen


The liver echotexture appears coarse although the liver surface and hepatic vein walls remain smooth in appearance. There is biphasic flow demonstrated within the main portal vein suggestive of portal hypertension. No other features however of portal hypertension with no upper abdominal masses, flow within the ligamentum teres or splenomegaly. No ascites demonstrated. The hepatic veins were patent. No focal liver lesion. No abnormal biliary dilatation.

The gallbladder was collapsed down. Right upper pole renal cyst. No hydronephrosis bilaterally.

Case Discussion

These ultrasound images demonstrate coarsened liver echotexture concerning for cirrhosis and signs of portal hypertension. 

The portal vein shows a predominantly antegrade, pulsatile, and biphasic-bidirectional flow. Biphasic flows are commonly seen in patients with tricuspid regurgitation, right-heart cardiac failure, and cirrhosis. In this case, the normal appearances of the hepatic veins and the morphological features of cirrhosis make it the most likely cause for the abnormal portal vein flow. 

The portal venous normal waveform should undulate smoothly and must always remain above the baseline.

Case courtesy of Dr Kenny Sim

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