Objective: The purpose of our study was to assess flow characteristics of vessels in the ligamentum teres fissure with color Doppler sonography in subjects without and with portal hypertension.
Subjects and methods: Color Doppler sonography of the ligamentum teres fissure was performed with either a 5.0- or a 7.5-MHz linear transducer in 55 consecutive thin healthy volunteers. Retrospective review was performed of sonograms of 21 consecutive patients with portal hypertension in whom blood flow in a paraumbilical vein was shown with 2.0- to 5.0-MHz sector/curved array transducers.
Results: Nine (16%) of the 55 healthy subjects had venous flow in the ligamentum teres fissure, which was hepatofugal in five and hepatopetal in four. Hepatofugal venous flow velocity in the ligamentum teres fissure did not exceed 5 cm/sec (mean, 3.2 cm/sec; SD, 1.0 cm/sec; range, 2-5 cm/sec), and flow extending anterior to the liver's surface was not noted with color Doppler sonography in the healthy subjects. In the 21 patients with portal hypertension, venous flow in the ligamentum teres fissure was always 7 cm/sec or greater (mean, 16 cm/sec; SD, 7.1 cm/sec; range, 7-33 cm/sec) and was shown by color Doppler sonography to continue beyond the anterior surface of the liver in 12 patients (57%).
Conclusion: Slow (< or = 5 cm/sec) hepatofugal venous blood flow may be detected in the ligamentum teres fissure in healthy subjects and by itself does not necessarily indicate portal hypertension. Hepatofugal venous flow in the ligamentum teres fissure with a velocity greater than 5 cm/sec or visualized with color Doppler sonography continuing anterior to the liver's surface is highly specific (100% in this series) for the presence of portal hypertension.