497

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Portal Vein by Real-Time

Measurements Sonography

Jeffrey Weinreb1 Sheila Kumari Gail Phillips Rubem Pochaczevsky

Real-time sonography affords a simple and reliable definition of the portal veins. A standard chart of normal portal vein measurements is presented. The mean diameter of the portal vein in 1 07 patients aged 21 -40 years was 1 1 2 mm. This information can be useful in evaluating portal hypertension in a variety of clinical situations.

Sonognaphy of the portal sonognaphy, and and reliable. abnormal on

has been found to be a valuable tool for diagnosing abnormalities venous system. With the development of real-time gray-scale evaluation of the portal venous system has become relatively simple While the medical literature sonognaphic portal venous actual measurements of the abounds with descriptions anatomy, little attention portal vein. This information of normal has been may be hypentenin a large

focused

particularly important in detecting and evaluating patients with portal sion. To obtain this data, we sonognaphically measured the portal veins series of normal patients.

Materials

and Methods

Consecutive abdominal sonograms performed during a 2 year period on patients aged 0-40 years were retrospectively reviewed. This age range was chosen because we were initially interested in establishing a portal vein standard for evaluation of patients with cystic
fibrosis. In all cases, the examinations were performed primarily to evaluate structures

other than the portal veins, including the liver, gallbladder, and right kidney. The only criteria for inclusion in this study were adequate visualization of the extrahepatic portal vein in the region of the porta hepatis and the absence of biliary, liver, or cardiac disease. A total of 1 48 sonograms met these criteria (83 female and 65 male patients). All studies were performed with a commercially available real-time mechanical sector scanner using a 3.5 MHz transducer through a water-path beam. The patients were examined in the supine, right anterior oblique, and left lateral positions during suspended inspiration. In general, the main portal vein was best and most readily seen with the patient in the right anterior oblique position in relation to the sound beam with 1 5#{176}-40#{176} of obliquity. Measurements of the portal vein were obtained at its broadest point just distal to the union of the
splenic and superior mesenteric veins (fig. 1).

Results
Received February 9, 1 982; accepted after

In 21 patients
was 8.5 2.7

aged
mm

0-10
(range,

years,
5-1

the mean
2 mm). In 20

diameter
patients

of the portal
aged 1 1 -20

vein

SD)
the

revision

May 3, 1982.

years,

All authors: Department of Radiology, Long Island Jewish-Hillside Medical Center, New Hyde Park, NY 1 1 042. Address reprint requests to S.

mean years,
aged

diameter was 10 2 mm (range, 7-13 mm). the mean diameter was 1 1 2 mm (range,
31 -40 years, the mean diameter was

In 49 patients aged 21-30 6-1 5 mm). In 58 patients

(range, 6-1 5 mm). The

Kumari.

1 1 2 mm

AJR 1 39:497-499,

September

1982

0361 -803X/82/1 393-0497 $00.00 American Roentgen Ray Society

overall mean diameter in 1 07 patients 2). There was no difference between and female patients.

aged 21 -40 years was 1 1 2 mm (fig. the portal venous measurements of male

498

WEINREB

ET

AL.

AJR:139,

September

1982

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Fig. 1 -A, B, Real-time

Main sagittal

portal vein sonogram

(PV) formed by confluence of splenic vein (SV) and superior in right anterior oblique plane. Site of portal vein measurement

mesenteric (arrows)

vein

(SMV). Site of portal vein measurement liver; C = inferior vena cava.

(arrows).

vein
.
S..

[6, [1 0],

7], and

portal other

vein

invasion to cystic

by

tumor

[8], [9],

and evidence

portal of

hypertension asis

secondary

fibrosis

schistosomi-

14S

causes

[1 1 ]. Sonognaphic

#{149}5SS#{149}

E E
LU

12S....

SSSSSSSSSS

SSSSSS,SSSS

SSSSSSSSSSSS

SS#{149}SSSSSSSSSS

portal hypertension has included lack of caliber variation in one of the major tributaries of the portal vein during breathing [1 2] and demonstration of portosystemic shunt such as esophagogastnic vanices [1 3, 1 4], patent umbilical vein
[1 5], and splenonenal shunt [16].

10-

S.....

$$SSSSSSS

SSSSSSSSSSSSSS

SSSSSSSSSSSSSS

S....

#{149}SS

#{149}S.

55

In light of the abundance

with normal and abnormal specifically have often confusion

of sonognaphic
portal veins,

literature
few studies

dealing
have

E
LU

8-

S5

S5#{149}

SSS

SSSS

S.

S.

S.

dealt with portal vein measurements. The results been at variance and have resulted in some in the sonognaphic portal literature. vein The diameter earliest of 6.3 study 2.3

Ia-

4-

reported a normal mean mm [1 1 ]. Other studies ported measurements mm [1 0]. In the most

on groups

of healthy

patients

ne-

2U

of 1 3.1 1 .7 mm [1 7] and 9.7 1.6 recent report [1 2], a mean portal vein was described. This measurewith our results in patients also in the in agreement normal
We did

0-10

11-20

21-30

31-40

diameter of less than 1 3 mm ment is in precise agreement aged

different

21 -40

years. caliber
of

We

were

in noting vein
evaluate

no
the

AGE IN YEARS
Fig. 2.-Portal
vein measurements in 40 patients.

significant effect Thus,

variations
respiration.

portal
not

during reported

phases

of the

Valsalva

maneuver,

which

has

been vein

to make Discussion Real-time

evaluate has been the nonmnvasively. sonognaphically vein thrombosis

the portal
it is safe

vein
to

more
assume

prominent
that

[13].
diameter

a portal

greaten gray-scale
portal vein Normal thoroughly

than

1 3 mm is a fairly

characteristic
setting. has yet

sign

of portal

sonognaphy
rapidly, sonognaphic described

has made
reliably, portal [1 -4].

it possible
anatomy

to
and seen

inexpensively, venous Abnormalities including of the

hypertension tivity and

in the specificity

appropriate clinical of this statement

The sensito be eluci-

dated
and with portal

in a large
it is probable hemodynamically vein may

series
that remain

of patients
in some effective small.

with

portal
of portal

hypertension,
hypertension shunt if used the in con-

cases

have also been [5], cavernous

described, transformation

portal portal

portosystemic Nevertheless,

AJR:139,

September

1982

SONOGRAPHY

OF

THE

PORTAL

VEIN

499

cases, it was
portal been

we were clinically
vein (fig.

able to identify portal hypertension manifest by measuring the caliber

3).

before of the size has

it addifor

In summary,
established be useful of the applications vein

a standard
and have will portal several been

for normal
clinical identified. for system

portal
situations

vein

in which sonognaphic a standard

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might tional portal evaluation

Undoubtedly, real-time using

be found venous

measurements.

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WM,

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in the porta hepatis:

variation
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of portal

venous
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Fig.
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3-25-year-old
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man

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at 1 7 mm

advanced
in diameter.

enlarged

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1 978;6

junction
sion,

with
it is likely

other
that

sonognaphic
the sonographic

criteria

for portal clinical

standard

diameter

may

be of value

in numerous

situations.

C, Douillet
D. Ultrasonographic a study

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of RH. J, twelve Portal

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in

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portal

venous

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arteniog-

diagnosis

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Br

Radio!

1980;
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raphy, While
ognaphy,

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ultrasound.

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of mortality
are thus

and morbidity
unacceptable suspected usually

and are time-consuming,

procedures

and they
portal

hypertension.
cirrhosis and angiognaphically, cedune

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only
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selected

patients

with

liver
10.

Chicago,

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are studied surgical proreal-time sonog-

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Z, Ahdel-Wahab
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MF, El-Kady
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ultrasonography

of

naphy

is simple
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it is reliable
can

and a
depict realmethod,

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Ultrasonography response in the of portal diminished

is suspected,

sonognaphy a standard example, compounding

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MC, Palaez AJR

J, RaIls

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to display into large

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: 459-463
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Schabel

Cunningham a sonographic 36: 157-159 in portal

situations, about the of acute

sonognaphy patency and

bulls-eye hypertension. A, Latz a subject

gastrointestinal

Kane sion:

S. The

of findings

rhage,

an enlarged

portal

vein

could

rapidly

identify

portal
1 7.

observation.

1982;1
Strohm
lubfrick

42:4S3-458
VWD,
und

hypertension as have successfully

a possible etiology. used sonographic

In our institution, we portography to screen

Wher

B. Korrelation

zwischem bestimmtem

LebervenverschyDurchmesser von Gastroentero!

sonographisch

adolescents onset and

and adult patients progress of portal

with cystic hypertension

fibrosis for the [9]. In some

Pfortader
1 7:695-703

und Milz bei Leberkranken.

1979;