So a patient presents with worsening peripheral edema and right upper quadrant discomfort. Biochemical data only reveals some mild elevation of the transaminases.

Here is what you see:

These are the right sided chambers.

And this is a hepatic vein.

 

What do you think is going on?  Scroll below for the answer!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This patient has severe tricuspid regurgitation. The second clip shows significant retrograde flow in the hepatic vein (red doppler signal). Hepatic congestion was the cause of pain.

Analysis of hepatic vein flow can be useful to establish the presence of right heart dysfunction when cardiac views are difficult.

 

cheers!

 

Philippe