DUPLEX-DOPPLER ENDOSONOGRAPHY IN THE DIAGNOSIS OF SPLENIC VEIN, PORTAL-VEIN, AND PORTOSYSTEMIC SHUNT THROMBOSIS

Background/Aims: Endoscopic ultrasonography is a promising procedure f or imaging mesenteric vascular structures. Methods: Duplex and color D oppler endosonography were used to prospectively evaluate 20 asymptoma tic paid volunteers. Subsequently, 11 patients with nondiagnostic tran sabdominal ultrasound and suspected thrombosis of the splenic and/or p ortal veins or a portosystemic shunt were evaluated with duplex endoso nography. The final diagnosis was based on CT, angiography, and/or sur gery or autopsy findings in 9 of 11 patients. Results: In normal volun teers, mesenteric vessel flow velocities and diameters were similar to previously described values. In 10 of the 11 patients with failed tra nsabdominal ultrasound, duplex endosonography was able to provide the correct diagnosis (accuracy of ultrasound 0% versus EUS 91%, p <.001). Mean portal vein diameter was greater in the patient group than in th e normal volunteers (18.5 mm versus 10.7 mm, p <.001) and all of the n ormal volunteers had a portal vein diameter less than 13 mm. No compli cations were experienced. Conclusion: Duplex endosonography allows vis ualization of the intra-abdominal vasculature and can be considered wh en transabdominal ultrasound is nondiagnostic in patients with suspect ed thrombosis of their splenic vein, portal vein, or portosystemic shu nt. EUS is able to identify indirect findings of portal hypertension i ncluding portal vein enlargement and venous collaterals.