In what condition can the ligamentum teres recanalize?

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When portal hypertension develops, the body forms collateral pathways to decompress the portal venous system. The ligamentum teres hepatis is the fibrous remnant of the fetal umbilical vein within the falciform ligament, and it can recanalize to create a patent paraumbilical channel that connects the portal system to systemic veins at the umbilicus. This recanalization is a classic sign of portal hypertension, most commonly due to cirrhosis. On ultrasound, you may see a tubular, echogenic structure within the falciform ligament with Doppler flow, representing flow from the portal system toward the umbilicus (a hepatofugal direction). The other conditions listed do not typically produce this collateral pathway.