Sonography case of the day

Abstract

A 41 -year-old woman with recent onset of jaundice, itching, and abdominal pain had splenomegaly. Caudate lobe enlargement was noted on abdominal sonography. Sonography also demonstrated multiple serpiginous anechoic structures in the splenic hilum and the left netropenitoneal region (figs. 1 A-i C). A CT scan (fig. 1 D) with iodinated contrast material confirmed these small tubular structures to represent dilated portosystemic venous collatenals developing in a setting of alcoholic cirrhosis and portal hypentension. Portal hypertension most commonly develops due to increased resistance to flow in the portal venous system secondary to alcoholic or postnecrotic hepatic cirrhosis. One major hemodynamic response in portal hypertension is the development of hepatofugal venous flow via multiple major portosystemic collateral veins. These abnormal collateral channels account for the major morbidity and mortality in the cirrhotic patient-hepatic encephalopathy and vaniceal hemorrhage. The portosystemic venous communications, occasionally documented by the barium swallow, are most accurately delineated with arterial on venous pontography. Sonographic demonstration of several of these