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

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. 

Terms used in radiology

Article information

rID: 19857
Synonyms or Alternate Spellings:
  • Reversal of portal venous flow
  • Hepatofugal
  • Hepatofugal portal venous flow
  • Reversed portal venous flow
  • Reversed flow in portal vein
  • Portal venous flow directed away from the liver
  • Inversion of portal venous flow
  • Portal venous flow inversion
  • Retrograde portal venous flow
  • Non-forward portal flow (NFPF)
  • Non-forward portal flow

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.