Hemodynamic evaluation of portal and umbilical venous flow with duplex ultrasound (US) was performed in 11 patients with cirrhosis of the liver and a large umbilical vein. Two of these patients had hepatofugal flow in the umbilical vein exceeding hepatopetal flow in the portal vein. These two patients had no evidence of esophageal varices and bleeding. The remaining nine patients had esophageal varices. In these patients, the hepatopetal flow in the portal vein exceeded the hepatofugal flow through the umbilical vein. The authors conclude that duplex US may help identify the massive hepatofugal flow through a large umbilical vein that may reduce the likelihood of esophageal varices and variceal bleeding.