高橋 正一郎¹, 石井 誠², 米山 啓一郎², 向井 常人², 三田村 圭二², 伊藤 洋二³, 川内 章裕³

Seiichiro TAKAHASHI¹, Makoto ISHII², Keiichiro YONEYAMA², Tsunehito MUKAI², Keiji MITAMURA², Youji ITO³, Akihiro KAWAUCHI³

¹富士吉田市立病院内科, ²昭和大学医学部第2内科, ³昭和大学医学部外科

¹Department of Internal Medicine, Fujiyoshida Municipal Hospital, ²Second Department of Internal Medicine Showa University School of Medicine, ³Department of Surgery Showa University School of Medicine

キーワード : Color Doppler echography, Extrahepatic portal venous obstruction (EHO), Portal vein cavernomatous transformation

We evaluated the clinical usefulness of color Doppler echography in diagnosing extrahepatic portal venous obstruction (EHO). The clinical application of Doppler color flow imaging for diagnosis of EHO has not been studied sufficiently. We examined 11 patients with EHO using SSH-65A and SSA-270A color Doppler echography equipment (Toshiba Co., Tokyo) with 3.75 MHz sector or convex probe. Patients were classified as primary (2 cases) or secondary (9 cases) EHO. Causes of the secondary form were considered to be liver cirrhosis, hepatocellular carcinoma, cholangitis, post-splenectomy or hematological disorder.
Blood flow in the portal vein and cavernomatous transformation was easily observed in all cases (100%) of EHO by color Doppler echography. EHO was diagnosed in 8 (73%) of 11 patients with EHO by B-mode ultrasonography.
Color Doppler echography was also evaluated for clinical usefulness and the following conclusions were revealed:
1. Blood flow and direction could be easily detected, and the velocity could be measured portal vein cavernomatous transformation.
2. It was possible to distinguish cavernomatous transformation from hepatic artery and bile duct in the porta hepatis.
3. Blood flows in non-obstructed portal vein and collateral veins could be evaluated.
Doppler color flow imaging is useful not only for diagnosing EHO, but also for evaluating portal hemodynamics.