1. Understand normal ultrasound appearance of portal veins in grayscale, color and spectral Doppler 2. Recognize abnormalities of the portal vein including thrombus (bland and tumor), cavernous transformation and portal venous gas 3. Identify abnormal waveforms and abnormal direction of flow in the portal veins and formulate a differential diagnosis 4. Understand the normal ultrasound appearance of a TIPS and recognize complications

1. Normal ultrasound of portal vein a. Anatomy i. 3D rendering of portal venous system b. Grayscale c. Doppler i. Color ii. Waveforms iii. Velocities 2. Abnormalities of flow a. Slow flow b. Helical flow c. Abnormal flow due to portal hypertension i. Alterations of velocity and direction 1. Hepatofugal flow: partial and complete 2. Perihepatic varices: paraumbilical, coronary, gallbladder 3. Portal Vein Thrombosis a. Bland thrombus 1. Causes 2. Acute versus chronic 3. Differentiating occlusive from non-occlusive b. Tumor thrombus 1. Hepatocellular carcinoma and other tumors 2. Grayscale, cine clips 3. Doppler: arterial flow within thrombus c. Chronic occlusion/Cavernous Transformation 4. Portal venous gas a. Causes b. Differentiate from pneumobilia c. Gray scale and Doppler appearance 5. Other a. Effect of cardiac disease on portal system b. Portal fistula i. Portal-hepatic venous ii. Portal-hepatic arterial 6. TIPS a. Normal appearance on Grayscale and Doppler i. when to image a TIPS after insertion ii. protocol for imaging a TIPS iii. effect on other vessels b. Complications i. Thrombus ii. Stenosis