Reversed pulsatile flow of the portal vein can occur secondary to increased hepatic outflow resistance from a mediastinal haematoma, even in the absence of tricuspid regurgitation.
May warrant mediastinal hematoma evaluation in unexplained portal flow reversal without tricuspid regurgitation; leaves open broader applicability.
The Doppler ultrasound pattern of reversed pulsatile flow (RPF) of the portal vein (PV) is strongly associated with high atrial pressure. Tricuspid regurgitation is considered to be the main cause of RPF in patients with chronic heart disease, but the precise pathomechanism of this PV flow pattern has not yet been resolved. We describe for the first time a RPF of the PV in a young patient with a mediastinal haematoma after inadvertent puncture of the subclavian artery. In this patient, transcutaneous echocardiography demonstrated normal valves without any tricuspid regurgitation as well as normal diameters of the cardiac cavities. The RPF of the PV in this patient resolved spontaneously within 7 days. An increased hepatic outflow resistance with transmission of hepatic artery pulsations across arterioportal communications seems the most likely pathomechanism to explain our finding.
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Görg et al. (2001) studied this question.
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