Ultrasound diagnostics of extrahepatic portal hypertension in children: a review of clinical cases

BACKGROUND: Ultrasound is a method of choice which is recommended in patients with portal hypertension for diagnosing and monitoring the disease, since it is informative, non-invasive, available and can be performed at patient’s bedside. The problem of portal hypertension in adults, methods of its diagnostics and treatment are widely covered in the medical literature. In clinical practice, portal hypertension in adults in most cases has an intrahepatic form and is associated with cirrhosis as the consequence of chronic liver diseases. Unlike in adults, portal hypertension in children is more often extrahepatic and is associated with some block to the blood flow through the portal vein. Portal vein impaired patency may be caused by thrombosis due to catheterization of umbilical vessels, omphalitis, peritonitis, developmental malformation of the portal system. A considerable difference in the frequency of portal hypertension forms in children and adults impacts the strategy of ultrasound diagnostic examination.

CLINICAL CASE DESCRIPTION: The article presents two clinical observations of extrahepatic form of portal hypertension in children aged one year one month and seven years. The authors demonstrate potentials and main aspects of ultrasound diagnostics in this pathology. They also underline the priority of assessing the portal system patency so as to detect cavernous transformation in the portal vein. Echographic signs such as changes in echogenicity and liver structure, presence of uneven bumpy contour, dilation of portal vessels, recanalization of the umbilical vein, ascites are not typical for the extrahepatic form of portal hypertension in children.

CONCLUSION: In children with extrahepatic portal hypertension, clinical manifestations such as enlarged abdomen, changed blood tests and ecchymoses on the body may be unnoticed for a long time. Bleeding from varicose veins of the esophagus and stomach is met as a frequent sign in children. Therefore, it is of particular importance to allocate newborn children from the risk group (with umbilical vascular catheterization, omphalitis, etc. in the anamnesis) to the special diagnostic group with detailed ultrasound examination of the liver, Dopplerographic assessment of portal vein patency so as to identify possible signs of portal hypertension as early as possible.