Hepatic venous outflow obstruction: evaluation with pulsed duplex sonography.

Pulsed Doppler sonography was performed in six patients with hepatic outflow obstruction (five with Budd-Chiari syndrome and one with hepatic venocclusive disease) to assess its usefulness in evaluating the altered hemodynamics in this disease. Doppler signals were obtained from the inferior vena cava (IVC) and from hepatic, collateral, and portal veins. Normally, the IVC and hepatic veins show phasic forward (toward the heart) flow. In Budd-Chiari syndrome, the blood flow in the IVC and hepatic veins was absent, reversed, turbulent, or continuous. These Doppler findings were thought to be characteristic of Budd-Chiari syndrome. The portal velocity was reduced (n = 4) or increased (n = 1). The former was considered typical of Budd-Chiari syndrome. In hepatic venocclusive disease the IVC and major hepatic veins showed normal phasic flow; flow velocity in the portal vein was increased. Doppler sonography was found to correlate well with therapeutic results and angiographic findings.