Short communication Abnormal hepatic vein Doppler waveform in patients without liver disease

In patients with liver cirrhosis Doppler ultrasound often detects absence of the retrograde (hepatopetal) flow phase in the hepatic vein, suggestive of an increased stiffness of the liver parenchyma around the vein. This is rarely or never reported in healthy control persons. We examined the frequency of absent retrograde flow in a consecutive series of 139 patients referred for abdominal ultrasound. We used state-of-the- art ultrasound scanners, and placed the Doppler gate so that in non-forced end-expiration it would sample the right hepatic vein 4-6 cm from the vena cava. There was no association between the hepatic vein flow pattern and age, sex or body mass index. 43 of 139 studied patients showed absent retrograde flow. Review of the case records revealed liver disease in 26 patients and no sign of liver disease in 17 patients. We suggest that absent retrograde flow in the hepatic veins may be seen not only in patients with overt liver disease but also in apparently liver-healthy patients. The hepatic vein Doppler waveform normally shows a triphasic pattern with two hepatofugal phases related to atrial and ventricular diastole, and a short phase of retrograde (hepatopetal) flow caused by the pressure increase in the right atrium at atrial systole (1). Absence of this retrograde flow phase is seen in about half of patients with cirrhosis, and is believed to reflect an increased stiffness of the liver parenchyma around the liver veins (1, 2). This pattern may also be seen in fibrosis, elevated aminotransferases, fatty liver, chronic hepatitis C and in metastatic liver disease (2-6). However, we have seen an abnormal curve on occasion in patients without known liver disease and without any other ultrasound indication of liver disease. It is not clear what action should be taken when an ''abnormal'' hepatic vein flow curve is unexpectedly revealed. In this study we therefore examine the frequency of abnormal Doppler curves in a sample of our patient population, and explore the possible explanations of the abnormal curves in apparently liver-healthy individuals.