Pulsatile portal vein sign is an uncommon finding which usually results when the elevated systemic venous pressure is transmitted through the hepatic sinusoids to the portal vein. It is most commonly seen with tricuspid regurgitation and is suggestive of underlying congestive heart failure. Case report A 34 year old female presented to the medical out patient clinic with complaints of jaundice for 2 weeks duration along with mild distension of abdomen. Past history was significant for a rheumatic valvular heart disease for past 16 years. There was associated history of dyspnoea on exertion and orthopnoea. On examination, the patient had mild hepatomegaly with ascites. The tip of spleen was palpable just below the costal margin. The patient also had a loud pan systolic murmur best heard over the tricuspid area.CBC was unremarkable. The hepatic enzymes and bilirubin were mildly elevated. Viral serologies were negative. Renal functions were normal. The patient was referred for an ultrasound scan to ascertain the cause of deranged hepatic function. Ultrasound scan through the liver revealed coarsened echo texture of liver with surface nodularity suggestive of cirrhosis (Figure-1). Spleen was mildly enlarged. Small amount of ascites was also seen. Doppler imaging of the portal vein revealed presence of pulsatile flow in the portal vein, which dropped below the baseline with each systole (Figure-2). Associated marked enlargement of IVC and hepatic veins was seen (Figure-3) with dilatation of cardiac chambers (right more than left). (Figure-4)Subsequent cardiac echo confirmed presence of multiple valvular diseases with predominant TR.
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