Doppler sonographic diagnosis of respiration-dependent reversed flow in the hilar splenic vein

We describe respiration-dependent reversed flow in the splenic vein detecte d by color Doppler sonography in 2 patients. In case 1, gray-scale sonograp hy in a patient with liver cirrhosis and abdominal pain showed a hyperechoi c, thickened colonic segment and diverticula, with increased echogenicity a round the diseased colon. The liver was small, with a nodular surface and c oarse echotexture. Doppler sonography of the portal and splenic veins showe d a constant hepatopetal flow while the patient held her breath in midinspi ration and a brief, transient color change restricted to the hilar splenic veins when the patient took a deep breath. In case 2, abdominal sonography in a patient with pneumonia and right-sided abdominal pain showed mural thi ckening of the appendix and left-sided pneumonic infiltration. The liver si ze and texture were normal. Color Doppler sonography of the portal and sple nic veins showed a constant hepatopetal flow while the patient held his bre ath in midinspiration and a transient reversal of flow restricted to the sp lenic veins when the patient took a deep breath. Although the cause of this flow pattern is unclear, increased intra-abdominal pressure is a possible explanation. (C) 2001 John Wiley & Sons, Inc.