Journal of Ultrasound (2018) 21:153–157
Detection of cavernous transformation of the portal vein
by contrast‑enhanced ultrasound
· Matthew A. Thimm
· Anthony L. Guerrerio
Received: 3 August 2017 / Accepted: 13 February 2018 / Published online: 13 March 2018
© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2018
Purpose Cavernous transformation of the portal vein can be missed on color Doppler exam or arterial phase cross-sectional
imaging due to their slow ﬂow and delayed enhancement. Contrast-enhanced ultrasound (CEUS) oﬀers many advantages
over other imaging techniques and can be used to successfully detect cavernous transformations of the portal vein.
Methods A 10-month-old female was followed for repeat episodes of hematemesis. Computed tomography angiography
(CTA) and magnetic resonance arteriogram (MRA) and portal venography were performed. Color Doppler exam of the
portal vein was performed followed by administration of Lumason, a microbubble US contrast agent.
Results Magnetic resonance arteriogram, CTA, and color Doppler exam at the time of initial presentation was unremarkable
without obvious vascular malformation within the limits of motion degraded exam. At 8-month follow-up, esophagogas-
troduodenoscopy revealed a vascular malformation in the distal esophagus which was sclerosed. At 6 month after sclerosis of
the lesion, portal venography revealed occlusion of the portal vein with extensive collateralization. Color Doppler revealed
subtle hyperarterialization and periportal collaterals. CEUS following color Doppler exam demonstrated extensive enhance-
ment of periportal collaterals. Repeat color Doppler after contrast administration demonstrated extensive Doppler signal in
the collateral vessels, suggestive of cavernous transformation.
Conclusions We describe a case of cavernous transformation of the portal vein missed on initial color Doppler, CTA and
MRA, but detected with contrast-enhanced ultrasound technique.
Keywords Contrast-enhanced ultrasound (CEUS) · Cavernous transformation · Portal vein
Scopo La trasformazione cavernomatosa della vena porta può sfuggire all’esame color Doppler o nell’arterial phase cross
sectional imaging a causa del ﬂusso lento e al ritardato enhancement. L’ecograﬁa con mezzo di contrasto (CEUS) oﬀre molti
vantaggi rispetto ad altre tecniche di imaging e può essere utilizzata per rilevare con successo i cavernomi della vena porta.
Metodi Una bimba di 10 mesi è stata seguita per ripetuti episodi di ematemesi. Sono state eseguite angiograﬁa con tomograﬁa
computerizzata (CTA) e angiograﬁa con Risonanza Magnetica (MRA) e ﬂebograﬁa portale. È stato eseguito l’esame color
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s4047 7-018-0288-3) contains
supplementary material, which is available to authorized users.
* Misun Hwang
Division of Pediatric Radiology and Pediatric
Neuroradiology, Russell H. Morgan Department
of Radiology and Radiological Science, Johns Hopkins
Hospital, 1800 Orleans St., Zayed Tower 4174, Baltimore,
MD 21287-0842, USA
Johns Hopkins University School of Medicine, Baltimore,
Department of Pediatrics, Johns Hopkins University School
of Medicine, Baltimore, MD, USA