To describe the multi-mode ultrasonographic features of hepatic sinusoidal obstruction syndrome (HSOS) and explore the value of ultrasound in the diagnosis of HSOS.

The clinical and ultrasonographic features of 33 patients with HSOS diagnosed from September 2014 to June 2018 at Zhongshan Hospital, Fudan University were retrospectively analyzed. Among them, five patients underwent contrast-enhanced ultrasonography and shear wave elastography. The size of the liver, hepatic echo, hepatic veins, portal veins, inferior cava vein, gallbladder, spleen, body cavity effusion, and hepatic elastic modulus were observed, and the Cochran-Armitage trend test was used to analyze the positive rate of ultrasonographic signs in patients of different severity.

Twenty-five (75.8%) cases had a history of taking Tusanqi, and most of the cases presented for abdominal distension, liver area pain, ascites, and liver function abnormalities. Gray-scale ultrasound detected 16 (48.5%) cases of hepatomegaly, 10 (30.3%) cases of hepatic echo enhancement and thickening, 11 (33.3%) cases of gallbladder wall thickening, 14 (42.4%) cases of splenomegaly, 31 (93.9%) cases of ascites, 9 (27.3%) cases of pleural effusion, and 7 (21.2%) cases of pelvic effusion. Color Doppler ultrasound revealed 20 (60.6%) cases of hepatic vein narrowing, 18 (54.5%) cases of abnormal hepatic venous waveforms, and 5 (15.2%) cases of portal vein narrowing. The mean portal veins flow velocity was (0.14±0.03) m/s, and 6 (18.2%) cases had portal vein regurgitation. Contrast-enhanced ultrasonography showed 5 (100.0%) cases of 'flower spotted' uneven enhancement in the arterial phase, hepatic artery to hepatic vein transit time was (22.3±3.3) s, portal vein to hepatic vein transit time was (13.0±2.2) s, and elastic modulus was 50.9±18.2 kPa. There was a correlation between the severity of the disease and the detection rate of hepatomegaly (Z=2.830, P=0.005), hepatic vein narrowing (Z=2.171, P=0.030), and abnormal hepatic venous waveforms (Z=2.840, P=0.005) .

HSOS is closely related to the use of herbal medicine Tusanqi. The ultrasonographic features of HSOS include hepatomegaly with liver echo enhancement and thickening, gallbladder wall thickening, splenomegaly, body cavity effusion; portal vein narrowing, reduced flow velocity, bidirectional blood flow, hepatic vein narrowing and abnormal hepatic vein waveforms; 'flower spotted' uneven enhancement in the arterial phase, prolonged hepatic artery to hepatic vein transit time and portal vein to hepatic vein transit time, and increased liver elastic modulus. Hepatomegaly, hepatic vein narrowing, and abnormal hepatic venous waveforms detected by ultrasound are positively related to clinical severity. Contrast-enhanced ultrasound and shear wave elastography have potential application value.