Diagnostic value of ultrasonography for post-liver transplant hepatic vein complications

Figure 5 Hepatic vein thrombosis in a 53-year-old female with decompensated hepatitis B cirrhosis. A: Grayscale ultrasound shows a solid hypoechoic mass within the middle hepatic vein lumen, not completely filling the vein; B: Color Doppler ultrasound shows no significant blood flow signal in parts of the hypoechoic mass within the middle hepatic vein lumen, with blood flow bypassing around the mass, suggesting hepatic vein thrombosis with incomplete luminal occlusion; C: Contrast-enhanced ultrasound (CEUS) shows a filling defect within the middle hepatic vein, with contrast agent flowing along the vein wall and encircling the thrombus, resulting in a consistent filling defect image; D: CEUS shows arterial phase hyperenhancement in the drainage area of the middle hepatic vein (segment 4, indicated by the arrow); E: CEUS shows delayed phase hypoenhancement in the drainage area of the middle hepatic vein (segment 4, indicated by the arrow). In this case, CEUS confirmed the presence of a middle hepatic vein thrombus, with hepatic parenchymal perfusion characteristics demonstrating arterial phase hyperenhancement and delayed phase hypoenhancement in the hepatic parenchyma of the drainage area. Surgical procedure: split liver transplantation (including right hemiliver with the middle hepatic vein). The donor liver was from a dextran-binding domain adult, split along the middle hepatic vein, with the right liver graft allocated to this patient. Ultrasound examination: 3 days postoperatively. Biochemical indicators showed elevated transaminases and bilirubin.