6. VExUS Score Step 3: PORTAL Vein Doppler Assessment

VExUS Score Step 3: PORTAL Vein Doppler Assessment

Acquiring the Portal Vein View with Ultrasound:

I find that the portal vein is probably the easiest vein to find (compared to the hepatic and intrarenal veins). This can be done by placing your probe in the right midaxillary line.

So here are the step to get the Hepatic Vein Doppler Tracings:

  1. Get a 2-D image of the Right Portal Vein
  2. Place color flow Doppler over the Right Portal Vein. You should see RED flow (towards the probe)
  3. Place your pulse wave Doppler gate on the Right Portal Vein
  4. Initiate Pulse wave Doppler
Portal Vein 2-D
Portal Vein 2-D

Interpretation of VExUS Score Ultrasound Portal Vein Doppler findings:

The Portal vein Doppler is normally monophasic with little to no variation. As venous congestion increases, there will be increasing amounts of pulsatility that is observed. The Pulsatility Index = (Vmax – Vmin)/Vmax.

Portal Vein Doppler

Normal Portal Vein Doppler
Portal Vein Doppler Grade 0

Mild Portal Vein Abnormality

Mild Portal Vein Abnl
Portal Vein Doppler Grade 1

Severe Portal Vein Abnormality

Severe Portal Vein Abnl
Portal Vein Doppler Grade 2