Fig. 10. Malignant portal vein thrombosis on conventional ultrasonography and contrast-enhanced ultrasonography (CEUS).

A. Color Doppler ultrasound shows patency of the hepatic artery (HA), but an absence of blood flow signals within the portal vein (PV), part of which appears filled with echogenic material (asterisk) consistent with thrombosis. No definite blood flow signals can be detected within the thrombus, suggesting the diagnosis of bland thrombus. B. A focused Clarify vascular enhancement mode image (Siemens Healthcare) shows a B-mode image of vessels with reduced noise and artifacts and with better definition (asterisk indicates thrombus). C. Portal venousphase CEUS image shows enhancement of the thrombus (blue cross mark) but relative wash-out compared with the hepatic parenchyma, which are findings that establish the diagnosis of malignant thrombosis.