Test yourself
Portal vein pulsatility: a congestion clue
5 questions. Pick an answer to see whether you are right and why. Your score appears at the end.
Question 1Normal portal vein flow on pulsed-wave Doppler is best described as:
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Answer c. The liver buffers the pressure waves of the right heart, so normal portal flow is steady and directed towards the liver. Reversal or stopping with each beat suggests raised right-sided pressure. Flow away from the liver suggests portal hypertension.
Question 2What does marked portal vein pulsatility suggest?
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Answer d. Pressure from the right heart reaches the portal vein when the right side is congested. A pulsing portal vein is a congestion clue, not a test of whether more fluid will help. Portal vein thrombosis shows absent flow or filling defects.
Question 3A portal vein has a maximum velocity of 20 cm/s and a minimum of 8 cm/s. What is the pulsatility fraction?
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Answer d. Pulsatility fraction = (20 minus 8) divided by 20 = 0.6, or 60%. A value of 50% or more is severely abnormal and suggests significant venous congestion, to interpret alongside the rest of the VExUS assessment.
Question 4Which approach combines the IVC with hepatic, portal and intrarenal venous Doppler?
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Answer d. VExUS (venous excess ultrasound) grades venous congestion using the IVC and Doppler of the hepatic vein, portal vein and intrarenal veins. eFAST looks for free fluid and pneumothorax in trauma. The BLUE protocol assesses lung in breathlessness.
Question 5Which patient might show a pulsatile portal vein without congestion?
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Answer b. Some healthy, thin young adults show portal pulsatility without raised right-sided pressure. Cirrhosis stiffens the liver and damps pulsatility. Portal vein thrombosis reduces or abolishes flow.
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