Failure of duplex sonography to diagnose hepatic artery thrombosis in a high-risk group of pediatric liver transplant recipients

Sue V. McDiarmid, Theodore R. Hall, Edward G. Grant, Allen L. Milewicz, Kim Olthoff, Juan Lois, Jorge Vargas, Marvin E. Ament, Ronald W. Busuttil

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Excellent correlation between angiographic findings and duplex sonography has been previously reported in the diagnosis of hepatic artery thrombosis (HAT), the most common technical complication of pediatric orthotopic liver transplantation (OLT). We now report a significant incidence of false-negative sonograms, ie, hepatic artery reported as patent but thrombosed on subsequent angiography. HAT was diagnosed in 10 of 57 pediatric OLT recipients evaluated prospectively by duplex sonography. In 5 patients HAT was diagnosed only by angiography even though arterial wave forms were observed on duplex sonography. Selective angiography demonstrated extensive collateral vessel formation arising from the superior mesenteric artery, the celiac axis, or both. The 5 patients shared very similar clinical courses marked by relapsing bacteremias with multiple enteric organisms, associated with focal infarctions of the liver. Four of the grafts had difficult arterial reconstructions and 3 of 5 had segmental bile duct dilation. We conclude that duplex sonography has proven to be a valuable screening tool in evaluating hepatic artery patency but must be correlated with angiography studies in a high-risk group of pediatric transplant patients characterized clinically by relapsing bacteremia and radiographically by false-negative duplex examinations.

Original languageEnglish (US)
Pages (from-to)710-713
Number of pages4
JournalJournal of Pediatric Surgery
Issue number6
StatePublished - Jun 1991


  • Hepatic artery thrombosis
  • orthotopic liver transplantation, pediatric, duplex sonography

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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