Colour-encoded duplex sonography

Fig. 35.12 Colour-encoded duplex sonography retrograde portal flow (flow inversion) in both branches and in the trunk of the portal vein due to arterioportal shunts...

Sonography In this biochemical constellation, sonography (also colour-encoded duplex sonography with visualization of the intrahepatic bile ducts) is the examination technique of choice, particularly when obstructive jaundice is suspected. There is evidence of prestenotically dilated bile ducts as well as, in some cases, accompanying strand-like, hyperechoic, infiltrating structures, which may be surrounded by a hypo-echoic margin. The tumour itself can be identified in most cases, particularly when it is localized in the liver hilum. 

Fig. 39.7 I Re-opened umbilical vein (VU) due to pronounced portal hypertension in haemochromatotic cirrhosis (VP = umbilical branch of the left portal vein) II Hepatofugal blood flow in the umbilical vein (VU) depicted by colour-encoded duplex sonography...

Previous shunt operations and TIPS need to be removed in order to guarantee that the transplanted liver is sufficiently supplied with portovenous blood. In these cases, the portal system is checked preoperatively for thromboses by means of colour-encoded duplex sonography and X-ray techniques. In any case, the confluence of superior mesenteric vein and splenic vein must be free. (391) The main advantage of portacaval end-to-side anastomosis is its low thrombosis rate of < 5% in addition, there is no need for a distal shunt ligature. In shunts distal to the hilus (mesocaval, distal splenorenal), no preparation of the liver hilus is required however, in 10% of cases, these shunts show portal vein thrombosis (in TIPS, up to 15%). Usually, all surgical shunts are disconnected or ligated before the liver transplantation is completed in order to... 

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