Congestive cardiac disease

Patients with cardiac failure frequently demonstrate dilated hepatic veins in the liver, sometimes with a dilated IVC. Although this may give the sonographer the overall impression of hypoechogenicity, due to the proliferation of large, anechoic vessels, the liver texture itself tends to be of either normal echogenicity, or, in the later stages of failure, hyperechoic.
Mitral valve disease may be the cause of altered waveforms in the hepatic veins; the usual triphasic flow becomes more pronounced, with a highly pulsatile waveform (Fig. below).
The portal venous waveform may sometimes be altered in cases of tricuspid valve regurgitation.
The normally monophasic flow may become bidirectional (Fig.Below). This phenomenon, associated with congestive heart failure, also occurs in cirrhosis prior to PV thrombosis. However the latter ‘balanced’ flow is of very low velocity (Fig. below), while that due to tricuspid regurgitation is a higher-velocity, more pulsatile waveform.
Ultrasound mages The waveform of the hepatic vein in a
patient with mitral valve disease demonstrates increased
Ultrasound images The portal vein has an abnormal, highly
pulsatile flow waveform in this patient with tricuspid
regurgitation. This is quite distinct from the low-velocity
‘balanced flow’ of portal hypertension
Ultrasound images of Balanced PV flow. Alternate
forward and reverse low-velocity flow on the Doppler
spectrum. The PV colour Doppler alternates red and blue.

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