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A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

Purpose: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS)., Materials and Methods: In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment)., Results: In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P < 0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26 +/- 7 cm/s at the portal venous end (P < 0.0001)., Conclusion: Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.

The radiologist must be familiar with all signs of the battered child syndrome to prevent misinterpretation. Important clinical signs are hematoma at different ages and in uncommon locations. The principle imaging signs are subdural hematoma, brain contusion and multiple skeletal injuries sometimes at different ages. The parents or the persons responsible for care often neglect mentioning an injury. The principle signs are shown and a diagnostic flow chart is presented.