Alternate pathways in hepatic venous outflow obstruction by color doppler imaging

Abstract

Introduction: Primary Budd - Chiari syndrome is a curable
form of portal hypertension. Doppler ultrasonography
is an excellent tool in the primary diagnosis of Budd Chiari
syndrome and in the follow up of patients after definitive
therapy. Methodology: Ninety-seven patients with clinically
suspected Budd Chiari syndrome underwent color Doppler
imaging to identify the site and cause for obstruction, flow
across the obstructed segment of the hepatic veins and / or
inferior vena cava and to identify the collateral pathways of
hepatic venous drainage. Sixty-two patients were subjected
to angiography and Doppler - angiography correlation was
also studied. Results: Seventy one out of the ninety seven patients
screened had Doppler evidence of Budd Chiari syndrome.
23.94%, 18.30%, 57.74% had type I, type II and type
III Budd chiari syndrome respectively. Intrahepatic "comma"
collaterals and inferior right hepatic vein were the major
collaterals identified in patients with type I and type III
disease. Doppler correlated with angiogram in 56 out of 62
patients (90.3%). Conclusion: Color Doppler imaging is an
excellent technique for qualitative data on flow direction and
pattern, thereby contributing significantly to the diagnosis.
It is the choice of investigation in the initial evaluation of patients
with suspected primary Budd Chiari Syndrome. It is
also recommended as a prime imaging procedure to determine
alternative venous pathways, stent and vessel patency
following intervention.