A prominent portal vein collateral, detected on duplex examination, confirms the diagnosis of portal vein hypertension (PVHTN). We present a patient referred to the vascular laboratory for a portal vein duplex ultrasound (DUS) examination with elastography. The most significant finding was retrograde (hepatofugal) flow in a prominent portal vein collateral located immediately adjacent to the main portal vein. This DUS examination highlights the techniques that identify spontaneous portosystemic shunts, thus confirming the presence of PVHTN.
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