What ultrasound finding indicates portal hypertension?

The finding that indicates portal hypertension is spleen enlargement, or splenomegaly. Portal hypertension is a condition characterized by increased blood pressure in the portal venous system, often resulting from conditions such as liver cirrhosis or hepatic vein thrombosis. When the portal vein experiences elevated pressure, it can lead to a backup of blood, increasing vascular congestion in the spleen and causing it to enlarge.

Spleen enlargement is a key indicator of portal hypertension because it reflects the underlying hemodynamic changes associated with the condition. In patients with portal hypertension, the spleen may not just be enlarged but can also exhibit various features on ultrasound, such as increased echogenicity due to congestion and possible formation of collaterals.

While occlusion of the intrahepatic portal vein might contribute to increased pressure and lead to various complications, it’s the overall effect of portal hypertension manifesting as spleen enlargement that serves as a clearer diagnostic marker in practice. Other findings, such as dilated bile ducts or an enlarged gallbladder, are typically associated with different pathologies, which do not directly indicate portal hypertension.