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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 213-214

Hepatofugal flow versus hepatopetal flow in portal vein on doppler: Its significance


Department of Radiodiagnosis, Acharya VinobhaBhave Hospital, DMIMS, Sawangi, Wardha, Maharashtra, India

Date of Submission05-Aug-2021
Date of Decision21-Nov-2021
Date of Acceptance07-Jan-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Prasanthi Ghanta
Department of Radiodiagnosis, Acharya VinobhaBhave Hospital, DMIMS, Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_301_21

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How to cite this article:
Ghanta P, Phatak SV, Dhawan VB, Gupta R, Manoj M. Hepatofugal flow versus hepatopetal flow in portal vein on doppler: Its significance. J Datta Meghe Inst Med Sci Univ 2022;17:213-4

How to cite this URL:
Ghanta P, Phatak SV, Dhawan VB, Gupta R, Manoj M. Hepatofugal flow versus hepatopetal flow in portal vein on doppler: Its significance. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 18];17:213-4. Available from: http://www.journaldmims.com/text.asp?2022/17/1/213/352232



Sir,

We present a case of hepatofugal flow discovered on color Doppler in a patient with cirrhosis of the liver with decompensated hepatic encephalopathy.

A 38-year-old man presented with abdominal distension, jaundice, and abdominal pain for 2 months. His liver enzymes were deranged. On ultrasonography, he was found to have a cirrhotic liver with altered echotexture, nodular surface, regenerative nodules, gross ascites, and normal portal vein diameter. On color Doppler, there was reversal of flow in the portal vein, demonstrating hepatofugal flow. There were no significant collateral channels in the patient. The normal direction of flow in the portal vein is always hepatopetal.[1] In cirrhotic patients, due to obstruction in distal sinusoids and hepatic venules, there is a concomitant increase in resistance to hepatic arterial as well as portal venous inflow causing the flow in the portal vein to reverse giving rise to hepatofugal flow or nonforward portal flow. Part of the reason is the hepatic artery facing the high resistance trying to decompensate through tiny intrahepatic arterioportal shunts and causing the reversal of flow in the portal vein. The hepatofugal flow may change to hepatopetal flow after taking food but this response can be blunted in most cirrhotic patients.[2] The direction of flow in the portal vein along with portosystemic collaterals are important to recognize on the color Doppler imaging in cirrhotic patients with portal venous hypertension. The reversal of flow indicates advanced portal venous hypertension.[3] The presence of hepatofugal flow can indicate greater hepatic dysfunction, and hence can result in a greater chance of hepatic encephalopathy, bleeding from varices, decreased response to endoscopic ligation of varices, and greater mortality. It also has an impact on therapeutic interventions such as chemoembolization in hepatocellular carcinoma and placement of transjugular intrahepatic portosystemic shunts since the liver has only hepatic arterial supply in such cases instead of the normal dual supply through the hepatic artery and portal vein found in patients with hepatopetal portal venous flow.[4] There are few known causes of hepatofugal flow of which cirrhosis is the most common one. Other causes include tricuspid regurgitation which can cause pulsatile hepatofugal flow in the portal vein, Budd–Chiari syndrome, arteriovenous fistula, and post-liver transplantation.[5]

To conclude, it is important to utilize the color Doppler to identify hepatofugal flow in cirrhotic patients. Hence, we present images depicting hepatofugal flow [Figure 1] in a decompensated cirrhotic patient compared to hepatopetal flow [Figure 2] taken from a normal control patient as seen on color Doppler imaging.
Figure 1: Color Doppler image demonstrating the hepatofugal flow in the cirrhotic patient with blue color depicting the reversed flow away from the liver toward the porta in the main portal vein and toward the USG probe. USG: Ultrasonography

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Figure 2: Color Doppler image demonstrating the normal hepatopetal flow in the normal control patient with red depicting the forward flow in the main portal vein toward the liver, away from the USG probe. USG: Ultrasonography

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Görg C, Riera-Knorrenschild J, Dietrich J. Pictorial review: Colour Doppler ultrasound flow patterns in the portal venous system. Br J Radiol 2002;75:919-29.  Back to cited text no. 1
    
2.
Wachsberg RH, Bahramipour P, Sofocleous CT, Barone A. Hepatofugal flow in the portal venous system: Pathophysiology, imaging findings, and diagnostic pitfalls. Radiographics 2002;22:123-40.  Back to cited text no. 2
    
3.
Mittal P, Gupta R, Mittal G, Kalia V. Association between portal vein color Doppler findings and the severity of disease in cirrhotic patients with portal hypertension. Iran J Radiol 2011;8:211-7.  Back to cited text no. 3
    
4.
Bryce TJ, Yeh BM, Qayyum A, Pacharn P, Bass NM, Lu Y, et al. CT signs of hepatofugal portal venous flow in patients with cirrhosis. AJR Am J Roentgenol 2003;181:1629-33.  Back to cited text no. 4
    
5.
Jeong WK, Kim KW, Lee SJ, Shin YM, Kim J, Song GW, et al. Hepatofugal portal venous flow on Doppler sonography after liver transplantation. Analysis of presumed causes based on radiologic and pathologic features. J Ultrasound Med 2012;31:1069-79.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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