From the Guidelines
Congestive hepatopathy on ultrasound is characterized by the presence of porto-systemic collaterals, which is a highly specific sign of clinically significant portal hypertension (CSPH) in patients with cirrhosis, as stated in the 2021 EASL clinical practice guidelines 1. The ultrasound findings of congestive hepatopathy may include:
- An enlarged liver with increased echogenicity
- Dilated hepatic veins and inferior vena cava
- Heterogeneous echotexture with prominent periportal cuffing
- Abnormal flow patterns in the hepatic veins, including dampened or reversed pulsatility
- Disproportionate enlargement of the caudate lobe
- Ascites in advanced cases However, the presence of porto-systemic collaterals on ultrasound is the most specific sign of CSPH, with a strong recommendation to routinely report this finding in patients with cirrhosis 1. According to the 2021 EASL guidelines, liver stiffness measurement (LSM) by transient elastography (TE) is also a validated tool for diagnosing CSPH, with a cut-off of >20-25 kPa 1. In addition, the combination of platelet count, spleen size, and spleen stiffness can be used as additional non-invasive tests to further improve risk stratification for CSPH 1. It is essential to note that the diagnosis of CSPH should be based on a combination of clinical, laboratory, and imaging findings, rather than relying on a single test or parameter 1.
From the Research
Ultrasound Findings of Congestive Hepatopathy
The ultrasound findings of congestive hepatopathy include:
- Enlarged and hypocollassing hepatic veins 2
- Signs of portal hypertension, such as hepatomegaly, ascites, splenomegaly, and porto-systemic collaterals 2
- Alterations in venous vessel flow and arterial resistance, including venous system hyperpulsatility, reduced velocity flow, and high resistance index in hepatic arterial Doppler spectrum 2
- Changes in liver elasticity, which can be detected by elastography 2
- Differences in hepatic venous opacification, which can be shown by contrastographic US 2
Doppler Ultrasound Findings
Doppler ultrasound findings of congestive hepatopathy include:
- Reduced velocity flow in the hepatic veins 2
- High resistance index in the hepatic arterial Doppler spectrum 2
- Venous system hyperpulsatility 2
- The Venous Excess Ultrasound Score can also be used to grade the severity of venous organ congestion, including congestive hepatopathy 3
Importance of Early Detection
Early detection of congestive hepatopathy is crucial to prevent complications, such as hepatic fibrosis and development of benign and malignant liver masses 4, 5. Ultrasound imaging, including Doppler ultrasonography, can play a key role in the early detection and diagnosis of congestive hepatopathy 4, 2.