Doppler sonography: a noninvasive method for diagnosis of membranous obstruction of IVC or hepatic vein

Evaluation of patients with portal hypertension

Patients with suspected portal hypertension must first be evaluated by physical examination, upper digestive endoscopy and ultrasonography with Doppler. Moreover, the evaluation of patients with portal hypertension depends on the cause of portal hypertension, the presence of complications and the specific treatment considered. Haemodynamic assessment with measurement of the hepatic venous pressure gradient is useful in confirming the origin of portal hypertension. This technique is the 'gold-standard' for evaluating haemodynamic treatments. Splanchnic and systemic circulation must also be measured. Quantitative evaluation of the splanchnic territory by Doppler sonography and other non-invasive investigations, may be performed. Further clinical studies are, however, needed to determine their interest in portal hypertension.

Use of Doppler ultrasonography in the evaluation of liver blood flow during silo reduction of a giant omphalocele

Despite the utility of prosthetic silo reduction techniques, surgical treatment of giant omphaloceles containing herniated liver may result in acute compromise of hepatic vascular flow. The authors report a case of an infant with a giant omphalocele containing liver, in whom hepatic vascular compromise was suspected during the course of prosthetic visceral reduction. Doppler ultrasonography performed on the herniated liver through the prosthetic silo demonstrated triphasic vascular flow in the liver as well as normal hepatic venous flow and vena caval flow, and permitted continued gradual visceral reduction and a safe, delayed primary abdominal wall closure on the seventh day of life. Doppler ultrasonography performed through the silo may be an important diagnostic adjunct during the visceral reduction phase of staged abdominal wall closure in infants with giant omphaloceles.