Q: Ultrasound technician called you to bedside to show images while doing sonography of Right Upper Quadrant (RUQ). On screen you see "pulsatile flow within the portal vein". What is your concern?


Answer: Tricuspid regurgitation and Right sided heart failure

In patients with portal hypertension due to right-sided heart failure with tricuspid regurgitation, flow within the portal vein usually appears pulsatile, unless patient is  cirrhotic which may make the portal wave-form flattened. This finding should be co-related with other clinical findings.