P1312 - Hepatic Pressure Mapping: Novel Utility of VExUS Scoring System

Iyad Al-bustami, MD, MPH(c)¹, Shamsa M. Qaadri, BSc², Shafiq Qaadri, BA³, Amogh R. Kare, BS², Saira Shah, MD⁴, Kenan Alrejjal, MBBS⁵, Kazi T. Haque, MD⁶, Nitish Mittal, MD⁷, Jennifer Ma, MD⁷, Shahzaib Ahmed, MBBS⁸, Aysha Rana, MD⁹, Salman Haider, MD⁴, Amr Dokmak, MD⁴, Ali Wakil, MD⁴, Kiran Zaman, MD^10
1Brooklyn Hospital Center, Houston, TX; ²St. George's University School of Medicine, Brooklyn, NY; ³Toronto Metropolitan University, Toronto, ON, Canada; ⁴Brooklyn Hospital Center, Brooklyn, NY; ⁵MedStar Health-Georgetown/Washington Hospital Center, Washington, DC; ⁶University of Texas Health, McGovern Medical School, Pearland, TX; ⁷University of Texas Health, McGovern Medical School, Houston, TX; ⁸Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Punjab, Pakistan; ⁹Brooklyn Hospital Center, Queens Village, NY; ¹⁰The Brooklyn Hospital Center, Brooklyn, NY

Introduction: Hepatic Venous Pressure Gradient (HVPG) is the gold standard for diagnosing and measuring the severity of portal hypertension. Recent diagnostic developments demonstrate the feasibility and accuracy of EUS-guided portal pressure gradient (EUS-PPG). However, both methods are invasive and can involve radiation. The Venous Excess Ultrasound (VExUS) scoring system quantifies systemic venous congestion based on Doppler interrogations and can be applied for hepatic pressure mapping in both acute and chronic conditions.

Case Description/Methods: The aim of the study was to present a novel use of the VExUS scoring system in diagnosing portal vein (PV) and hepatic vein (HV) congestion and to evaluate the severity of venous pathology through two scenarios.

Patient 1: A 39-year-old female with a recent diagnosis of hepatic epithelioid hemangioendothelioma presented with epistaxis and petechiae on her body for two days. Mental status was at baseline. Total bilirubin was 31.8, direct bilirubin >15, AST 504, ALT 116, ALP 1479, albumin 2.4, INR 2.5, and creatinine 3.1. Calculated MELDNa score was 41. CT triple phase showed evidence of left and mid HV, and left PV thrombosis. Abdominal doppler showed IVC of 4cm, severe decrease in HV phasicity and increase in pulsatility index >60% of the PV. VExUS grade 3.
Patient 2: A 72-year-old female with untreated chronic Hep C presented with acute onset RUQ pain. CT abdomen showed a hepatic lesion with left PV thrombosis. Liver enzymes were slightly elevated AST 75, ALT 85; otherwise, the blood profile was normal. Doppler US revealed a mildly enlarged liver with a smooth contour, 5.5cm mass in the left lobe of the liver, an IVC diameter of 1.5 cm, a well-circumscribed hypoechoic heterogeneous mass with internal vascularity in the left side of the porta hepatis representing a tumor thrombus PV. Main PV remained patent with normal hepatopetal flow. VExUS grade 0.

Discussion: The presence of PV/HV thrombus isn’t sufficient for hepatic malfunction; however, the degree of congestion in the HV/PV greatly contributes to hepatic insult & malfunction. VExUS scoring quantifies congestion noninvasively and radiation-free while providing significant details not readily available in other imaging modalities (ex. CT,MRI). While VEsUS is relatively new, the physiology behind it is well-validated. It can be potentially used as a dynamic marker to prognosticate individuals in isolation or with other noninvasive markers for PV hypertension & to optimize liver pressures while on treatment.



Disclosures:


Iyad Al-bustami, MD, MPH(c)¹, Shamsa M. Qaadri, BSc², Shafiq Qaadri, BA³, Amogh R. Kare, BS², Saira Shah, MD⁴, Kenan Alrejjal, MBBS⁵, Kazi T. Haque, MD⁶, Nitish Mittal, MD⁷, Jennifer Ma, MD⁷, Shahzaib Ahmed, MBBS⁸, Aysha Rana, MD⁹, Salman Haider, MD⁴, Amr Dokmak, MD⁴, Ali Wakil, MD⁴, Kiran Zaman, MD¹⁰. P1312 - Hepatic Pressure Mapping: Novel Utility of VExUS Scoring System, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.