Doppler Patterns In Abdominal Vessels PDF

Doppler Patterns In Abdominal Vessels  Celiac Axis Scan transversely, look for “seagull” High systolic flow, some diastolic flow. Some spectral broadening Flow does not change after meals 2  Hepatic Artery...

Doppler Patterns In Abdominal Vessels  Celiac Axis Scan transversely, look for “seagull” High systolic flow, some diastolic flow. Some spectral broadening Flow does not change after meals 2  Hepatic Artery Scan transversely, try porta hepatis or through ribs. Low resistance flow—lots of diastolic component Spectral Broadening is present Approx. 11% of hepatic arteries arise from the SMA Always check in heart transplant pts! Occlusion of the Hepatic Artery is a life- threatening complication!  Similar Image Pg. 185 Fig 8-76 B. Transverse Hepatic Artery Flow Pg. 198 4  Splenic Artery Most turbulent celiac branch—tortuous vessel Prone to aneurysm, especially in pts with chronic pancreatitis Always do Doppler exam of pancreatic pseudocysts, could be aneurysm instead. 5  Superior Mesenteric Artery Scan from sagittal plane Usually high resistance in fasting state After meal, becomes nonresistive with enhanced diastolic flow. Use Doppler of SMA to diagnose stenosis or occlusion of mesenteric vessels. 6  Similar Image Pg. 185 Fig. 8-76 D. Pg. 198 fig. 9-52 B. Sagittal SMA High resistance-fasting pt. with Low diastolic 7  Renal Artery The Main Renal Artery has low resistance pattern. Continuous flow provides constant perfusion to renal tissues. Spectral Broadening present Flow is dampened as get more peripheral into the kidney 8  Renal Artery Stenosis Very difficult to diagnose in native kidneys because can’t see entire vessel. -Renal Artery Occlusion can ONLY be diagnosed if entire vessel is examined. -Another problem is that pts with RA occlusion will quickly develop collaterals which may be mistaken for the renal artery. 9  Renal Artery Stenosis Also, at least 30% of patients have - multiple renal arteries. -If there is separation of the renal pelvis, DO NOT simply assume that it is hydronephrosis—USE DOPPLER—it may just be prominent renal vessels.  Renal Transplants In the main renal artery there is normally turbulence at the anastomosis (connection made at vessels from new kidney to transplant patient) -Only 12% of transplant pts develop RA stenosis (will see distal turbulence) -RA occlusion easier to diagnose because there is only one artery feeding the transplanted kidney. 11  Renal Transplant Rejection Normal transplants have low resistance flow. During rejection, resistance increases—have less and less diastolic flow. -May use Pulsatility Index or Resistive Index to quantify. RI of.7 or less=good perfusion RI of.7 to.9= possible rejection RI >.9=probable rejection 12 Doppler Patterns in Abdominal Vessels Renal Veins- - variable flow like IVC. -May be invaded by tumor or clot. -Always check in transplant patients 13 Doppler Patterns in Abdominal Vessels Normal Rt. Renal Vein flow Similar image Pg. 187 Fig. 8-79 8th Ed. Pg. 201 fig. 9-56 Rt. Renal Vein flow Flow above and below baseline like the IVC pattern 14 Doppler Patterns in Abdominal Vessels 7. Inferior Vena Cava- -Variable waveform. -Always check for tumor or clot. 15 Doppler Patterns in Abdominal Vessels 8. Hepatic Veins- -If normal have a variable pattern similar to IVC. Budd-Chiari Syndrome -thrombosis of hepatic veins. -rare disease-associated with: hematologic disorders,oral contraceptives,collagen disease,echinococcus,times just before/after pregnancy Sonographic Appearance-hepatic veins appear small/filled with echogenic 16  IVC Waveform Pg. 187 Fig. 8-81 A. Flow above and below baseline reflecting reflux of blood from Rt. Atrium during systole and variations 17 IVC/Hepatic Veins Pg. 179 Fig. 8-81 C. Complex waveform Above and below Baseline- reflux with Respiratio ns IVC/Hepatic Veins Pg. 179 Fig. 8-81 B. Triphasic flow of Hepatic veins with: Systolic (S), Diastolic (D) and atrial (a) components  Doppler Patterns in Abdominal Vessels 9. Portal Vein Toward Liver/Hepatopetal - -Relatively continuous flow at low velocities -Varies with respirations -With thromobosis—see thrombus in the PV, also, dilated SMV, Splenic Vein 20 Normal Portal Vein Flow Pg. 188 Fig. 8-82 Monophasic and Hepatopetal flow (toward the liver) 21  Doppler Patterns in Abdominal Vessels Cavernous Transformation of Portal Vein- -collaterals around the portal vein in patients with chronic PV obstruction. Diagnostic Criteria: 1.Extrahepatic PV not seen 2.Echogenic area at porta hepatis due to fibrosis 22 Cavernous Transformation (not in text)  Portal Hypertension -Usually result of intrinsic liver disease (cirrhosis or cancer, PV thrombosis) -Portal flow is hepatofugal-away from liver (Chronic) 24  Portal Hypertension Doppler Findings: -Low velocity in Portal Vein -Patent Umbilical Vein (ligamentum Teres) - (definitive diagnosis) -Flow varies from patient to patient -Loss of respiratory variation 25  Portal Hypertension 2-D Ultrasound Findings: -DilatedPortal, Splenic, Superior Mesenteric Veins -Patent Umbilical Vein -Varices (Collaterals) -Splenomegaly w/dilated vessels -Decreased Respiratory Response 26 Portal Hypertension Pg. 226 Gig. 9-38 A. Flow Revers al In Main Portal vein Portal Hypertension Pg. 226 Gig. 9-38 B. Flow Revers al In Main Portal Vein- Below the baselin e