Reversed portal vein pulsatility on Doppler ultrasound secondary to an iatrogenic mediastinal haematoma

The Doppler ultrasound pattern of reversed pulsatile flow (RPF) of the port al vein (PV) is strongly associated with high atrial pressure. Tricuspid re gurgitation is considered to be the main cause of RPF in patients with chro nic heart disease, but the precise pathomechanism or this PV flow pattern h as not yet been resolved. We descibe for the first time a RPF of tile PV in a young patient with a mediastinal haematoma after inadvertent puncture of the subclavian artery. In this patient, transcutaneous echocardiography de monstrated normal valves without any tricuspid regurgitation as well as nor mal diameters of the cardiac cavities. The RPF of tile PV in this patient r esolved spontaneously within 7 days. An increased hepatic outflow resistanc e with transmission of hepatic artery pulsations across arterioportal Commu nications seems the most likely pathomechanism to explain our finding.