SPLENIC VENOUS FLOW EXCEEDING PORTAL VENOUS FLOW AT DOPPLER SONOGRAPHY - RELATIONSHIP TO PORTOSYSTEMIC VARICES

OBJECTIVE. The purpose of this study was to determine if the Doppler s onographic finding of hepatopetal flow in the splenic vein that exceed s hepatopetal flow in the portal vein is associated with portosystemic varices. MATERIALS AND METHODS. Sixty-four patients with chronic live r disease were studied retrospectively. In 32 patients, splenic venous flow exceeded portal venous flow (S > P group); in 32 patients, porta l venous flow exceeded splenic venous flow (P > S group). All patients were evaluated with Doppler sonography and CT of the upper part of th e abdomen. Upper endoscopy was performed within 3 months of sonography in 44 of the 64 patients. RESULTS. In the S > P group, mean splenic v olume was significantly larger (p = .02) than in the other group. The prevalence of varices as determined by CT in the esophageal, coronary, and peripancreatic regions was also higher in this group (p less-than -or-equal-to .01). When esophageal varices were present, they were jud ged on the basis of their CT appearance to be massive in 50% of the S > P group and in 0% of the P > S group. Upper endoscopy revealed esoph ageal varices in 92% of the S > P group and in 55% of the P > S group (p < .005). Bleeding esophageal varices were noted in 75% of the S > P group and in 30% of the P > S group (p < .01). CONCLUSION. Patients w ith chronic liver disease and the Doppler sonographic finding of splen ic venous flow that exceeds portal venous flow have an increased preva lence of portosystemic varices, which tend to be larger and more likel y to bleed.