Periportal Cuffing: An extremely rare ultrasonographic phenomenon

Aim: To investigate the prevalence of periportal cuffing of the liver and correlate ultrasonographic findings with clinical data in order to more precisely characterize the relevance of this extremely rare phenomenon.

Methods: From April 2002 till April 2008 about 10.500 abdominal examinations were performed by a single physician in the interdisciplinary ultrasound unit of the University Hospital Marburg. During this time, n=100 patients (62 male/38 female) with periportal cuffing of the liver were detected qualifying for the retrospective study design. Echomorphology of periportal cuffing was evaluated and clinical diagnoses of the underlying diseases were clustered into four main groups: Liver diseases, haematological diseases, bowel diseases and others.

Results: The mean age of the patients was 57.06 years (SD±19.47). Periportal cuffing was echo-poor in n=9 (9%) and echogenic in n=91 (91%). Liver diseases (n=30, 30%) were malign n=9 (30.3%), autoimmune n=7 (23.3%), infectious n=7 (23.3%) and cholestatic n=6 (20%). Bowel diseases (n=36, 36%) were malign n=7 (19.4%), chronic inflammatory n=14 (38.9%) and others n=15 (41.7). Haematological disorders (n=15, 15%) were chronic myoproliferative n=2 (13.3%), lymphoma n=7 (46.7%), leukaemia n=5 (33.3%) and 1 ß-thalassaemia minor. Other diseases accounted for 18 (18%) of cases, 1 healthy case (1%) was also detected.

Conclusion: Periportal cuffing of the liver is an extremely rare ultrasonographic phenomenon. The pathogenesis and clinical significance remains obscure. Diseases associated with periportal cuffing are heterogeneous and most commonly arise from the liver or the gastrointestinal tract. Interestingly, crohn's disease and ulcerative colitis are the most frequent diagnoses associated with periportal cuffing.

Keywords: periportal cuffing, inflammatory bowel diseases, crohn's disease, ulcerative colitis