Sonographic hemodynamic evaluation of spleno-renal shunt using the Valsalva maneuver
ABSTRACT PurposeThe purpose of this study was to assess the characteristic features of hemodynamic changes in portal venous hypertension with
spleno-renal shunt on conventional B-mode and color Doppler imaging before and after the Valsalva maneuver.
Materials and methodsA total of 11 patients with portal venous hypertension underwent conventional B-mode and color Doppler ultrasound during follow-up
examinations. Sonographic imaging of the splenic vein and the left renal vein was performed before and after the Valsalva
ResultsIn the six patients with spleno-renal shunt formation, dilated left renal veins were depicted after the Valsalva maneuver.
In the five patients without spleno-renal shunt, there was no apparent dilatation of the left renal vein either before or
after the Valsalva maneuver. In all six patients with spleno-renal shunt, color flow mapping of the left renal veins was emphasized
during the Valsalva maneuver. In the five patients without spleno-renal shunt formation, there were no apparent changes on
color flow mapping of the left renal vein before or after the Valsalva maneuver.
ConclusionThe sonographic findings of the splenic vein and the left renal vein on conventional B-mode and color Doppler imaging before
and after the Valsalva maneuver are useful for diagnosis of spleno-renal shunt and for grading the hemodynamic changes caused
by spleno-renal shunt.
KeywordsPortal venous hypertension-Spleno-renal shunt-Collateral circulation-Color Doppler ultrasonography-Hemodynamics
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ABSTRACT: Unusual to-and-fro waveforms were demonstrated in the left gastric vein on Doppler sonograms in four patients with liver cirrhosis. The patterns of the to-and-fro waveforms were diverse in each of the patients: both hepatopetal and hepatofugal flow occurred in a single waveform in case 1, changes in the flow direction with flow interruption were noted in case 2, and changes in flow direction without observation of flow interruption and changes after meals were noted in cases 3 and 4, respectively. These waveforms may represent a transitional phase during the development of a portal systemic shunt in patients with portal hypertension.Journal of Medical Ultrasonics 04/2011; 39(2):101-104. DOI:10.1007/s10396-011-0329-4 · 0.62 Impact Factor