case_images: PMC6662413_01
case_images: Portal vein Doppler exam performed 4hrs after ROSC on day 1. There is a biphasic portal vein profile with flow reversal. Maximum and minimum velocities are 13 and 5.76 cm/s, respectively. Pulse is 85 beats per minute (bpm). Portal vein pulsatility fraction is greater than 100 %. Ascites is present.
case_images: CRICC2019-9591823.001.jpg
case_images: PMC6662413_01_CRICC2019-9591823.001.jpg
case_images: fig1
case_images: Bedside point of care ultrasound was remarkable for a moderately reduced biventricular function; a significantly dilated inferior vena cava and a high portal vein pulsatility fraction (Figure 1).
case_images: Portal vein Doppler exam on day 3. Maximum and minimum velocities are 22.3 and 9.98 cm/s, respectively. Pulse is 102 bpm. Portal vein pulsatility fraction is 59 %. Ascites is once again noted.
case_images: CRICC2019-9591823.002.jpg
case_images: PMC6662413_01_CRICC2019-9591823.002.jpg
case_images: fig2
case_images: Repeat bedside portal vein assessment (Figure 2) showed a substantial decrease in portal vein pulsatility fraction.
case_images: PMC6662413_02
case_images: Biphasic portal vein Doppler profile with flow reversal performed on day 1. Pulsatility fraction more than 100 % with heart rate at 95 bpm.
case_images: CRICC2019-9591823.003.jpg
case_images: PMC6662413_02_CRICC2019-9591823.003.jpg
case_images: fig3
case_images: Bedside portal vein assessment showed a biphasic portal vein pattern consistent with venous congestion (Figure 3). Significant improvement in symptoms, serum sodium levels (120 to 136 meq/L), and a decrease in the portal vein pulsatility fraction (Figures 3 and 5) was also seen.
case_images: Hepatic vein Doppler exam on day 1. Evidence of systolic flow reversal (green arrow).
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case_images: fig4
case_images: Hepatic vein Doppler was also suggestive of volume congestion (Figure 4).
case_images: Portal vein Doppler exam on day 3. The pulse was 90 bpm. The pulsatility fraction was less than 20%.
case_images: CRICC2019-9591823.005.jpg
case_images: PMC6662413_02_CRICC2019-9591823.005.jpg
case_images: fig5
case_images: Significant improvement in symptoms, serum sodium levels (120 to 136 meq/L), and a decrease in the portal vein pulsatility fraction (Figures 3 and 5) was also seen.