Hepatofugal or non-forward portal flow (NFPF) is an abnormal flow pattern in which the portal venous flow is from the periphery of the liver towards the porta and backwards along the portal vein. This phenomenon is not uncommon in patients with liver disease 3.
It is the opposite of hepatopetal.
Hepatofugal flow can be demonstrated on angiography, Doppler ultrasonography, magnetic resonance imaging, and/or CT. Doppler ultrasound however tends to be the best modality at quantifying this abnormality.
cirrhosis with portal hypertension
- considered the most common cause of hepatofugal flow in the portal venous system 3
- usually tends to be continuous reversal rather than pulsatile reversal
- indicates advanced portal hypertension
- cirrhotic patients with hepatofugal flow are thought to have greater hepatic dysfunction, a higher incidence of hepatic encephalopathy, variceal bleeding and higher mortality compared with cirrhotic patients with hepatopetal flow 5
- can change back to hepatopetal flow after ingestion of food, which is considered to on the basis of a postprandial increase in splanchnic venous flow and portal venous flow, this phenomenon however may be blunted in patients with cirrhosis 3
- Budd-Chiari syndrome
- tricuspid regurgitation: tends to have reversed pulsatile flow (RPF) in portal vein.
- arterioportal fistula in liver
- post liver transplantation 7
History and etymology
The term hepatofugal derives from the Ancient Greek 'hepar' meaning 'liver' and Latin 'fugare' meaning 'to flee' referring to the direction of flow away from the liver.
- 1. Görg C, Wollenberg B, Beyer J. Reversed portal vein pulsatility on Doppler ultrasound secondary to an iatrogenic mediastinal haematoma. Br J Radiol. 2001;74 (886): 962-4. Br J Radiol (citation) - Pubmed citation
- 2. Tarantino L, Giorgio A, De stefano g et-al. Reverse flow in intrahepatic portal vessels and liver function impairment in cirrhosis. Eur J Ultrasound. 1997;6 (3): 171-177. Eur J Ultrasound (link) - Pubmed citation
- 3. Wachsberg RH, Bahramipour P, Sofocleous CT et-al. Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls. Radiographics. 22 (1): 123-40. Radiographics (citation) - Pubmed citation
- 4. Von herbay A, Frieling T, Häussinger D. Color Doppler sonographic evaluation of spontaneous portosystemic shunts and inversion of portal venous flow in patients with cirrhosis. J Clin Ultrasound. 2000;28 (7): 332-9. J Clin Ultrasound (link) - Pubmed citation
- 5. Bryce TJ, Yeh BM, Qayyum A et-al. CT signs of hepatofugal portal venous flow in patients with cirrhosis. AJR Am J Roentgenol. 2003;181 (6): 1629-33. AJR Am J Roentgenol (citation) - Pubmed citation
- 6. Kondo T, Maruyama H, Sekimoto T, Shimada T, Takahashi M, Yokosuka O. Reversed portal flow: Clinical influence on the long-term outcomes in cirrhosis. World journal of gastroenterology. 21 (29): 8894-902. doi:10.3748/wjg.v21.i29.8894 - Pubmed
- 7. Jeong WK, Kim KW, Lee SJ, Shin YM, Kim J, Song GW, Hwang S, Lee SG. Hepatofugal portal venous flow on Doppler sonography after liver transplantation. Analysis of presumed causes based on radiologic and pathologic features. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 31 (7): 1069-79. Pubmed
- 8. Charlton T. Lewis, An Elementary Latin Dictionary
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