Sonographic hemodynamic evaluation of spleno-renal shunt using the Valsalva maneuver

Purpose The purpose of this study was to assess the characteristic features of hemodynamic changes in portal venous hypertension with spleno-renal shunt on conventional B-mode and color Doppler imaging before and after the Valsalva maneuver. Materials and methods A total of 11 patients with portal venous hypertension underwent conventional B-mode and color Doppler ultrasound during follow-up examinations. Sonographic imaging of the splenic vein and the left renal vein was performed before and after the Valsalva maneuver. Results In the six patients with spleno-renal shunt formation, dilated left renal veins were depicted after the Valsalva maneuver. In the five patients without spleno-renal shunt, there was no apparent dilatation of the left renal vein either before or after the Valsalva maneuver. In all six patients with spleno-renal shunt, color flow mapping of the left renal veins was emphasized during the Valsalva maneuver. In the five patients without spleno-renal shunt formation, there were no apparent changes on color flow mapping of the left renal vein before or after the Valsalva maneuver. Conclusion The sonographic findings of the splenic vein and the left renal vein on conventional B-mode and color Doppler imaging before and after the Valsalva maneuver are useful for diagnosis of spleno-renal shunt and for grading the hemodynamic changes caused by spleno-renal shunt.