Percutaneous transhepatic portography and splenoportography were compared in 67 patients with portal hypertension. Portograms were evaluated without knowledge of the identity of patients. Factors evaluated included technical success of the examination; visualization of the portal vein, splenic vein, and other tributaries; contrast medium density, portal blood flow direction; presence and type of collaterals and varices; and liver size and configuration. Percutaneous transhepatic portography proved superior with regard to delineation of the portal venous system and esophageal varices. A definite diagnosis of portal vein thrombosis was possible only with the transhepatic approach.