Ultrasonographic and splenoportographic evaluation of patients with portal hypertension

Different ultrasonographic [US] and splenoportographic findings and their relation to splenic pulp pressure [SPP] were evaluated in 50 patients with portal hypertension [PH] secondary to liver cirrhosis and/or schistosomal hepatic fibrosis [SHF]. The mean SPP was 35.77 +/- 7.14 ml saline and portal vein diameter [PVD] by US and 16.74 +/- 4.28 mm. There was a weak positive correlation between SPP and PVD = 0.1. Twenty one [42%] had history of hematemsis. The mean grade of esophgeal varices [2.19 +/- 1.66 VS 1.07 +/- 1.62], SPP [36.43 +/- 7.59 VS 31.76 +/- 4.77 ml saline] were significantly more in patients who had history or hematemesis than those without [P < 0.05 and < 0.05 respectively]. The mean PVD [17.6 +/- 4.1 VS 13.8 +/- 2.2 mm] and SPP [33.7 +/- 3.8 VS 29.6 +/- 6.8 ml saline] were significantly more in patients who had shrunken liver than those with enlarged liver P < 0.05. The means of PVD, SPP and grade of esophageal varices were significantly more in patients who had past history of schistosomiasis and US evidence of periportal thickening suggestive of SHF. Thirty four [68%] cases did not have changes in the caliber of splenic vein [SV] or superior mesenteric vein [SMV] with respiration. Patients without caliber variation had a significantly higher means of grade of esophageal varices, SPP and number of collaterals as seen by splenoportography and US. Splenoportography had more success rate in demonstration of coronary, short gastric veins and esophageal varices. While US had more success rate in demonstration of the umblical and splenorenal collaterals. In conclusion inspite of some limitations of US, it has several advantages that justifies its wide spread use in screening pf patients with portal hypertension