Valsalva manoeuvre

The Valsalva manoeuvre can be used to assess autonomic function or to terminate a supraventricular tachycardia. 

Burcharth, F., Berthenssen, K. The influence of posture, Valsalva manoeuvre and coughing on portal hypertension in cirrhosis. Scand. J. Chn. Lab. Invest. 1987 39 665-669... 

Fig. 5.3. a Scan of the anterior abdominal wall with Valsalva manoeuvre shows the ventral hernia containing the bowel loops (BO) and the defect in the fascia (arrows), b Fatty epigastric hernia with herniation of the properitoneal fat (arrows), c Spigelian hernia shows the defect marked by calipers lateral to the rectus muscle (R) and the contents (BO) limited anteriorly by the Spigelian fascia (arrow), d Richter s type umbilical hernia shows fluid-filled hernial sac (arrowheads) and irreducible herniation of only a part of the circumference of the bowel (arrow), which showed wriggling peristaltic movement in real time... 

Liver veins easily depictable as far as the periphery, <6 mm, no wall echoes, lumen fluctuations during Valsalva s manoeuvre... 

The portal vein is 5-8 cm long with a diameter of 1.2 0.2 (or 0.97) cm. The portal venous pressure is 3-7 (-12) mmHg. It is dependent on several criteria posture, intra-abdominal pressure (e. g. coughing, compression), respiratory phase, Valsalva s manoeuvre and a number of biochemical mediators. (20)... 

Valsalva s manoeuvre. Tests for the sympathetic nerves system involve blood pressure response to standing and the Quantitative sudomotor axon reflex test (QSART) [11]. Abnormal test results are associated with premature cardiovascular disease and death in diabetic patients. 

Doppler ultrasound is the initial modality of choice to differentiate venous malformations from other vascular abnormalities. Ultrasound is performed with a high-frequency linear array transducer (5-12 MHz). On grey-scale images, venous malformations appear as compressible hypoechoic or heterogeneous lesions [15,16] (Fig. 2.2a-c). Calcifications (demonstrated in less than 20% of cases), are quite specific of venous malformation anechoic channels can be seen. Doppler examination displays a monophasic low-velocity flow (Fig. 2.3). In 20% of venous malformations, no flow can be demonstrated. Dynamic manoeuvres such as Valsalva or manual compression are sometimes necessary to induce a visible Doppler flow. 

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