Mild tricuspid regurgitation (hepatic vein Doppler)

Case contributed by Dr Matt A. Morgan

Presentation

Routine Doppler evaluation of a patient presenting to the emergency department with mildly increased liver function tests (AST and ALT both less than 100).

Patient Data

Gender: Female

The middle hepatic vein shows a normal periodic waveform, however, there is a subtle abnormality.

The a wave is slightly exaggerated and s wave is slightly diminished (shorter than the d wave), findings that can be seen in tricuspid regurgitation.

Annotated images with the inflection points of the a, s, v, and d waves labeled.

Normally the a wave is not so prominent. The s wave is usually larger than the d wave as well.

Case Discussion

Alterations in the normal hepatic vein Doppler waveform may indicate cardiac or liver disease.

In this waveform, the abnormality is subtle, but compatible with mild tricuspid regurgitation.

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