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

AbstractWe describe respiration‐dependent reversed flow in the splenic vein detected by color Doppler sonography in 2 patients. In case 1, gray‐scale sonography in a patient with liver cirrhosis and abdominal pain showed a hyperechoic, thickened colonic segment and diverticula, with increased echogenicity around the diseased colon. The liver was small, with a nodular surface and coarse echotexture. Doppler sonography of the portal and splenic veins showed a constant hepatopetal flow while the patient held her breath in midinspiration 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 thickening of the appendix and left‐sided pneumonic infiltration. The liver size and texture were normal. Color Doppler sonography of the portal and splenic veins showed a constant hepatopetal flow while the patient held his breath in midinspiration and a transient reversal of flow restricted to the splenic 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. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:527–530, 2001.