Internal Medicine, Albertinen Hospital, Hamburg, Germany.
Institute for Radiology, Albertinen Hospital, Hamburg, Germany.
Ultraschall Med. 2023 Aug;44(4):408-413. doi: 10.1055/a-1797-9986. Epub 2022 Apr 28.
Hepatic portal venous gas (HPVG) is a rare clinical finding, often caused by a severe underlying disease. In the literature as well as in clinical practice, HPVG is considered "signum malum" with a poor prognosis and bowel ischemia as the most common cause. Most studies are based on the results of computed tomography (CT) examinations. The aim of this retrospective study is to report on the prevalence, causes, and clinical course of HPVG in a monocentric cohort of abdominal ultrasound (US) investigations.
The US database of an academic teaching hospital was searched with specific keywords (timespan 01/2000 to 12/2020). Reports, pictures, and clinical data of all cases with HPVG were re-evaluated.
Out of 134 804 US examinations, 8 HPVG cases were identified. There was a wide variety of underlying diseases, with mesenteric ischemia being seen in only 2 cases. 5 patients were discharged in stable condition, with 4 of them having undergone surgical treatment. 2 patients who had rejected further measures died, and one was lost to follow-up.
HPVG is a rare phenomenon in clinical US. However, ultrasonographic prevalence is comparable to the prevalence in CT studies. Underlying diseases are mostly severe, and in nearly all cases an underlying cause can be found by thorough investigation. In some cases, US may even be superior to CT scans for the detection of HPVG. Despite its rarity, every sonographer should know the typical sonographic presentation of HPVG, and appropriate images should be included in US teaching modules.
肝门静脉气栓（HPVG）是一种罕见的临床发现，通常由严重的潜在疾病引起。在文献和临床实践中，HPVG 被认为是“不良征象”，预后不良，肠缺血是最常见的原因。大多数研究都是基于计算机断层扫描（CT）检查的结果。本回顾性研究旨在报告在腹部超声（US）检查的单中心队列中 HPVG 的患病率、病因和临床过程。
使用特定关键字搜索一家学术教学医院的 US 数据库（时间范围为 2000 年 1 月至 2020 年 12 月）。重新评估所有 HPVG 病例的报告、图像和临床数据。
在 134804 次 US 检查中，发现了 8 例 HPVG。潜在疾病种类繁多，仅 2 例为肠系膜缺血。5 例患者病情稳定出院，其中 4 例接受了手术治疗。2 例拒绝进一步治疗的患者死亡，1 例失访。
HPVG 在临床 US 中较为罕见。然而，超声检查的患病率与 CT 研究的患病率相当。潜在疾病大多严重，通过彻底调查几乎所有情况下都能找到潜在原因。在某些情况下，US 甚至可能优于 CT 扫描来检测 HPVG。尽管它很罕见，但每个超声医师都应该了解 HPVG 的典型超声表现，并在 US 教学模块中包含适当的图像。
