Wednesday, 14 January 2015

xrayoftheweek 2: what heart condition does this liver US indicate?

This is a still image from an ultrasound study, no prizes for which organ this is (as I haven't removed the label!). The questions are:
1. What vessel is the Doppler trace from?
2. What cardiac abnormality does this indicate?

This is a Doppler trace of a portal vein. It is abnormal because it is biphasic. This usually indicates raised right heart pressures secondary to tricuspid regurgitation. A normal portal vein Doppler trace should be monophasic with a little variation in maximum and minimum velocity, with no reversal of flow. In this particular case, when the line drops below the 0 cm/s level, there is reversal of flow. Another, but much rarer, cause of this Doppler trace is an arterio-portal or arterio-right heart fistula. Tricuspid regurgitation and right heart failure can lead to hepatic congestion and enzyme derangement, and eventually to liver cirrhosis ("cardiac cirrhosis"). 

Read more about this pattern of Doppler trace in this AJR article and here is another example on the excellent RadPOD website which has unfortunately stopped publishing new cases.

#xrayoftheweek #FOAMRad #FOAMed #FOAMus