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Reversed portal vein pulsatility on Doppler ultrasound secondary to an iatrogenic mediastinal haematoma

Department of Internal Medicine, Philipps University, Baldingerstraße, 35043 Marburg, Germany

View larger version (167K): [in a new window]   Figure 1. Chest radiograph showing enlargement of the mediastinum.

View larger version (49K): [in a new window]   Figure 2. CT demonstrating a mediastinal haematoma and a small haemopericardium around the right atrium.

View larger version (30K): [in a new window]   Figure 3. Doppler wave form of the hepatic veins (left), the portal vein (middle) and the hilar splenic vein (right). The Doppler trace of the hepatic vein shows a regular triphasic flow pattern with a pronounced retrograde phase. A marked pulsatile pattern with temporarily reversed flow is seen in the portal vein and the splenic vein.

View larger version (38K): [in a new window]   Figure 4. On follow-up examination, the pathological flow pattern has resolved. The Doppler trace of the hepatic vein (left) now shows a regular phasic wave form. A regular continuous hepatopetal flow is seen in the portal vein (middle) and the splenic vein (right).