0:00

So this is an example of monophasic flow within the hepatic veins.

0:05

If you think about what the hepatic vein waveform normally looks like, it has a lot

0:09

of respiratory variability and goes significantly above and below the baseline.

0:13

This is the evaluation of the right hepatic vein.

0:16

You can see we have some variability here.

0:19

It goes close to baseline, and there's even areas where it might slightly blip

0:23

above the baseline there. And then when we move over to the middle hepatic vein,

0:27

you can see we have some less variability.

0:30

We have small areas of dips here and there, maybe some questionable spots where it

0:36

goes above the baseline. Sometimes it's hard to tell whether that's truly noise or

0:40

not, but you do see decreased variability throughout this waveform.

0:47

And then as we go over to the left hepatic vein, you can see that they denoted the

0:51

patient was not holding their breath here.

0:53

We see rapid changes that is related to that breath hold, so we're going to ignore

0:58

this portion. We're going to focus more on what we see here.

1:01

What some authors will describe as monophasic flow, sometimes they will describe it

1:06

as it must be completely flat and have no variability whatsoever.

1:10

Some will describe if you don't go to the baseline, it's considered monophasic

1:15

flow, and some will vary between those two factors.

1:21

So it really just depends on the interpreter and what they say.

1:24

It's not that one is right or one is wrong, but they are varying degrees of a

1:28

similar process. And as we go through this, you can sort of see we're

1:34

starting to see a little bit of nodularity in the liver surface.

1:38

It's not extreme, and some of the liver even looks a little bit more smooth, but

1:41

some of this is a little bit more lumpy bumpy.

1:43

One of the most common things that we see this diagnosis in is cirrhosis.

1:48

Because of that fibrosis in the liver, you don't have that normal freedom of

1:52

movement of the hepatic veins, and they don't flex quite as well in the setting of

1:56

a fibrotic liver.