Color Doppler demonstration of segmental portal flow reversal: An early sign of hepatic veno-occlusive disease in an infant

Hepatic veno-occlusive disease (HVOD) is a relatively frequent complication of bone marrow transplantation (BMT), with a reported prevalence of 1% to 54%. The role of color duplex ultrasonography (CDU) in the diagnosis and monitoring of HVOD is controversial; some authors advocate its use, whereas others find it insensitive and nonspecific. Hepatofugal flow in the main portal vein is regarded as a relatively specific finding of severe HVOD; however, it is of limited value because it seldom occurs. Here we report HVOD in an infant who previously underwent BMT. The HVOD was diagnosed early by demonstration of hepatofugal flow in only 1 segmental portal vein. After treatment with high-dose methylprednisolone and defibrotide, CDU showed reversal to hepatopetal flow accompanied by marked clinical improvement.