Journal Information
Vol. 47. Issue 7.
Pages 419-420 (July 2023)
Vol. 47. Issue 7.
Pages 419-420 (July 2023)
Images in Intensive Medicine
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VExUS: Severe systemic congestion with normal portal flow
VExUS: congestión sistémica severa con flujo portal normal
M.J. Arche Banzoa,
Corresponding author

Corresponding author.
, L. Segovia García de Marinab, R. Vicho Pereirac
a Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
c Servicio de Medicina Intensiva, Clínica Rotger, Palma de Mallorca, Spain
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This is the case of an 86-year-old man admitted to the ICU due to right-sided heart failure (RSHF) after Mitraclip® implantation, severe chronic pulmonary hypertension, acute kidney injury, and elevated levels of transaminase and bilirubin. The VExUS (Venous Excess Ultrasound Score) system was used. Fig. 1 shows flow reversal during ventricular systole on the Doppler echocardiography of suprahepatic veins (red arrows). Fig. 2 shows the monophasic renal interlobar venous Doppler flow pattern (lack of venous flow [blue arrows] in systole [white arrows]). Both findings are suggestive of severe systemic venous congestion (SVC). However, portal vein Doppler (PVD) (Fig. 3) was not pulsatile (as it would have been expected in SVC). Cirrhosis-induced portal fibrosis (due to RSHF) prevents the transmission of pulsatility across venous flow being PVD, in this case, not assessable with the VExUS to diagnose SVC due to being a false negative outcome.

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