ARRT Ultrasound Practice Test

In portal hypertension, the resistance to flow within the liver increases, so the portal venous pressure rises and blood can reverse direction. The portal vein normally carries blood toward the liver (hepatopetal), but when Doppler shows hepatofugal flow, the blood is moving away from the liver. This reversal is a classic sign of significant portal hypertension and is often accompanied by reduced velocity and dampened flow, reflecting the high downstream resistance. Other patterns—flow toward the liver, continuous high-velocity flow, or no flow—do not align with the typical hemodynamic changes seen with portal hypertension.