The importance of color and pulsate Doppler in portal high blood pressure on infants

Introduction: The evolution of hepatic cirrhosis on infants is dependent of etiology, mezenchimal activity intensity and therapeutic measures. Every evolution outcome reduces the morphofunctional capacity of the liver. The diagnostics and degree of disease can be established on the base of clinical, biological and histological parameters. Severity classification of Child Pugh cirrhoses is based on nutritional status, presence or absence of ascites, portal encephalopathy, and biological markers resulting in three evolution stages – A, B, C – with different prognostic values.

Method: Our study was made on a group of 60 children examined in Centrul Medical Advitam Medicis and Clinica Pediatrie II Timişoara with two ultrasound machines, Toshiba and Hospitex. On these children, hepatic cirrhoses in different stages were established between 1997 and 2007 with ultrasound in mode B, Doppler Triplex, CT, MRI and laboratory.

Results: In all cases we have imagistic evaluated echo density, echo structure, presence of ascites, caudal hepatic lobe dimensions, spleen dimensions, portospleenic axe and we have conducted hepatic biopsy.

Triplex Doppler sonography has spread as noninvasive diagnostic method most likely for small vessels. This has brought us some arguments related to portal high blood pressure: appreciation of vascular diameter (portal, suprahepatic, spleen veins), caliber variations and respiratory movement ratio, presence and direction of blood flow, velocity decreasing, increasing of congestion index (ratio between the area of an transversal portal vein section and average blood flow speed), installation and localization of thrombosis in the port vein and identification of other possible complications.

We tried to establish some ultrasound indicators to contribute for a better staging of the Child Pugh cirrhoses.

As a conclusion we can say that Triplex Doppler Sonography is a very important and adequate method for evaluating patients with different stages of cirrhoses and it offer's the possibility to make a certain prognostic for the disease development.