Objective To analyze the application of enhanced CT scan and ultrasound in the diagnosis of portal hypertension liver cirrhosis with esophageal variceal bleeding. Methods 40 patients with portal hypertension liver cirrhosis confirmed by clinicopathological diagnosis in the hospital from January 2013 to September 2017 were enrolled in the study. Their clinical data and imaging data were analyzed retrospectively. According to the results of gastrointestinal endoscopy and the presence of variceal bleeding, the patients were grouped. The diameter of main portal vein (MPV), diameter of left gastric vein (LGV), portal vein congestion index (PV-CI), hepatic vein damping index (HV-DI), hepatic arterial arriving time (HAAT) and hepatic vein interval time (HV-HA) were compared. The value of items with significant differences in the diagnosis of portal hypertension liver cirrhosis with esophageal variceal bleeding was analyzed by ROC curve. Results There were 19 cases with variceal bleeding (the bleeding group) and 21 cases without (nonbleeding group). The LGV and HV-DI in bleeding group were significantly higher than those in the non-bleeding group, and HA-HA was significantly lower than in nonbleeding group. ROC curve analysis showed that the positive thresholds of LGV, HV-DI and HV-HA in predicting variceal bleeding were 6.00mm, 0.66 and 5.50s, respectively. The diagnostic sensitivity showed LGV (82.87%) > HV-DI (75.57%) > HV-HA (46.26%), and the specificity showed HV-HA (84.57%) > LGV (78.36%) > HV-DI (69.19%). Conclusion Enhanced CT scan and ultrasound have their own advantages in the diagnosis of portal hypertension liver cirrhosis with esophageal variceal bleeding, in terms of sensitivity and specificity.