Portal hypertension is suggested when the main portal vein diameter exceeds 13 mm and Doppler shows which combination of features?

• A. Hepatofugal, Pulsatile Flow with Decreased Velocity
• B. Hepatopetal, Monophasic Flow with Increased Velocity
• C. Triphasic Portal Flow with Normal Velocity
• D. Absent Portal Flow

Answer: (A)

Portal hypertension alters how the portal vein drains blood, and Doppler findings reflect that congested state. The key signals are flow directed away from the liver (hepatofugal), a pulsatile waveform from transmitted cardiac pulsations, and a slower overall flow velocity. This combination—hepatofugal, pulsatile flow with decreased velocity—fits portal hypertension best because the increased resistance in the liver slows the flow and pushes it back toward the portal system’s origin, while cardiac pulsations become more evident in the Doppler signal.

The other patterns don’t fit as well: flow toward the liver (hepatopetal) suggests normal or lower resistance than seen with portal hypertension; a triphasic pattern in the portal vein is not typical (portal flow is normally monophasic with mild pulsatility, not a classic triphasic arterial pattern); and absent portal flow points to portal vein thrombosis or occlusion rather than portal hypertension per se.