Pulsatile Portal Vein Flow Reversal

This 57 year-old male presented with a known history of tricuspid regurgitation for assessment of hepatomegaly. This pulsed-wave doppler ultrasound examination of the portal vein demonstrates highly pulsatile flow with intermittent flow reversal. The other findings (not shown) were hepatomegaly and biphasic hepatic vein flow.
Tricuspid regurgitation is associated with hepatic congestion and may lead to hepatic fibrosis if severe. Pulsatile flow in the portal vein (reversed or non-reversed) is associated with tricuspid regurgitation. Portal vein pulsatility index has been shown to correlate with severity of tricuspid regurgitation.
Reversal of flow may also be seen with advanced hepatic cirrhosis, however the portal venous pulsatility is usually not increased.
References:
1. Abu-Yousef MM, Milam SG, Farner RM. Pulsatile Portal Vein Flow: A Sign of Tricuspid Regurgitation on Duplex Doppler Sonography. AJR 155 (4): 785-788, 1990
2. Loperfido F, et al. Doppler analysis of portal vein flow in tricuspid regurgitation. J Heart Valve Dis. 2(2):174-82, 1993
Credit: Dr Laughlin Dawes
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