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Cawich SO, Gardner MT, Barrow M, Barrow S, Thomas D, Ragoonanan V, Mahabir A, Ali R, Naraynsingh V. Inferior Hepatic Fissures: Anatomic Variants in Trinidad and Tobago. Cureus 2020; 12:e8369. [PMID: 32617240 PMCID: PMC7326303 DOI: 10.7759/cureus.8369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Classic descriptions of the visceral surface of the human liver only define three fissures: transverse, sagittal and umbilical fissures. Any additional fissures that are present on the visceral surface of the liver are considered variant inferior hepatic fissures (IHFs). This study was carried out to document the prevalence of IHFs in the Eastern Caribbean. Knowledge of these variants is important to clinicians who treat liver disorders in persons of the Caribbean diaspora. In this study, two independent researchers observed all consecutive autopsies performed at the facility over a period of 10 weeks. They examined the visceral surface of the unfixed liver in situ. Any specimen with variant IHFs was selected for detailed study. We documented the relation of the variant IHFs to nearby viscera and then explanted the livers using a standardized technique. The following details were recorded for each liver: number, location, depth, length, and width of IHFs. All measurements were checked independently by two researchers and the average measurement was used as the final dimension. Each liver was then sectioned in 1 cm sagittal slices to document the relationship of intraparenchymal structures. We observed 60 consecutive autopsies in unselected cadavers. Variant IHFs were present in 21 (35%) cadavers at a mean age of 68.25 years (range: 61 - 83; median 64.5; standard deviation (SD) ± 8.45). The variants included a deep fissure in the coronal plane between segments V and VI in 19 (31.7%) cadavers (related to the right branch of the portal vein in 63.2% of cases), a well-defined segment VI fissure running in a sagittal plane in four (6.7%) cadavers, a well-defined fissure incompletely separating the caudate process from the caudate lobe proper in five (8.3%) cadavers, a consistent fissure that arose from the left side of the transverse fissure and coursed between segments II and III in three (5%) cadavers, and a deep coronal fissure dividing the quadrate to form an accessory quadrate lobe in one (1.7%) cadaver. Almost one in three unselected persons in this population have anatomically variant fissures on the visceral surface of the liver. The variants include Rouvière's sulci (31.7%), caudate notches (8.3%), segment VI fissures (6.7%), left medial segment fissures (5%), and quadrate fissures (1.7%). The clinical relevance of these variants is discussed. Any clinician treating liver diseases in persons of Caribbean extract should be aware of their presence.
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Affiliation(s)
| | | | | | - Shaheeba Barrow
- Pathology, Port of Spain General Hospital, Port of Spain, TTO
| | - Dexter Thomas
- Surgery, Port of Spain General Hosptial, Port of Spain, TTO
| | | | | | - Reyad Ali
- Pathology, Port of Spain General Hosptial, Port of Spain, TTO
| | - Vijay Naraynsingh
- Surgery, Medical Associates Hospital, St. Joseph, TTO
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
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The hepatoduodenal ligament revisited: cross-sectional imaging spectrum of non-neoplastic conditions. Abdom Radiol (NY) 2019; 44:1269-1294. [PMID: 30448917 DOI: 10.1007/s00261-018-1829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The hepatoduodenal ligament is frequently involved by conditions affecting the portal triad and surrounding structures, including a vast array of non-neoplastic conditions. Due its unique location between the retroperitoneum and the peritoneal space, the hepatoduodenal ligament is also targeted by inflammatory conditions involving the retroperitoneum and the liver. Finally, the presence of lymphatics and of the biliary tracts makes the hepatoduodenal ligament a route of spread for a variety of infections. The purpose of this pictorial essay is twofold: to review the cross-sectional radiological anatomy and variants of the structures within the hepatoduodenal ligament, and to illustrate the non-neoplastic conditions that may arise within the hepatoduodenal ligament. CONCLUSION Familiarity with these specific entities and their cross-sectional imaging findings is fundamental for a more accurate diagnosis.
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Sharma M, Rameshbabu CS, Dietrich CF, Rai P, Bansal R. Endoscopic ultrasound of the hepatoduodenal ligament and liver hilum. Endosc Ultrasound 2018; 7:168-174. [PMID: 27824022 PMCID: PMC6032695 DOI: 10.4103/2303-9027.193584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The porta hepatis and hepatoduodenal ligament (HDL) are important anatomical pathways of extension of disease to and from the liver. The imaging of this area is difficult. The role of endoscopic ultrasound (EUS) as an imaging modality for hepatoduodenal ligament has not been established so far. All images in the present study have been generated from a detailed review of real time recordings using the curved linear scanning echoendoscope EG -3830 UT (Pentax Corporation, Tokyo, Japan), coupled with a Hitachi avius and Hitach 7500 processor (Hitachi Aloka Medical, Tokyo Japan). Our image orientation is with the cranial aspect of the patient directed toward the right side of the screen. We have illustrated that with a careful technique, a detailed EUS evaluation of the HDL and hepatic hilum is possible. A thorough understanding of the HDL anatomy by curved linear EUS probe may play a crucial role in the accurate diagnosis of a broad spectrum of pathologic conditions of the porta hepatis. EUS examination of the HDL should be a part of the upper abdominal EUS studies. The description and the images described in this article are useful for beginners who want to start imaging of the porta hepatis and hepatoduodenal ligament. This information is useful for staging of malignancies involving common bile duct.
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Affiliation(s)
| | | | - Christoph F Dietrich
- Caritas Krankenhaus Bad Mergentheim Internist, Gastroenterologe und Proktologe Hämatologe-Onkologe, Pneumologe Geriater/Arzt für Palliativmedizin Chefarzt der Med, Bad Mergentheim, Germany
| | - Praveer Rai
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | - Raghav Bansal
- Mount Sinai Elmhurst Hospital Center, Elmhurst, New York, USA
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Tidebrant G, Hafström LO, Topp S, Tylén U. Resectability of Liver Tumours Evaluated by Computed Tomography. Acta Radiol 2016. [DOI: 10.1177/028418518802900508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a retrospective study of CT examinations of liver tumours in 37 patients intra- and extrahepatic tumour growth was estimated in order to see if resectability could be predicted. The findings were compared with the evaluation at laparatomy. Four out of 15 tumours, resectable according to CT, turned out to be unresectable and 9 out of 37 CT examinations did not reveal the total extent of tumour growth. A more reliable preoperative radiologic assessment may be obtained by improvement of current CT techniques, by computed tomographic angiography, intraoperative ultrasound or MR imaging.
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Tirumani SH, Shanbhogue AKP, Vikram R, Prasad SR, Menias CO. Imaging of the porta hepatis: spectrum of disease. Radiographics 2015; 34:73-92. [PMID: 24428283 DOI: 10.1148/rg.341125190] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A wide array of pathologic conditions can arise within the porta hepatis, which encompasses the portal triad (the main portal vein, common hepatic artery, and common bile ducts), lymphatics, nerves, and connective tissue. Major vascular diseases of the portal triad include thrombosis, stenosis, and aneurysm. Portal vein thrombosis can complicate liver cirrhosis and hepatocellular carcinoma and has important therapeutic implications. Hepatic artery thrombosis and stenosis require immediate attention to reduce graft loss in liver transplant recipients. Congenital (eg, choledochal cyst) and acquired (benign and malignant) diseases of the biliary system can manifest as mass lesions in the porta hepatis. Lymphadenopathy can arise from neoplastic and nonneoplastic entities. Uncommon causes of mass lesions arise from nerves (eg, neurofibroma, neurofibrosarcoma) and connective tissue (sarcomas) and are rare. The hepatoduodenal ligament is a peritoneal reflection at the porta hepatis and is an important route for the spread of pancreatic and gastrointestinal cancers. Imaging plays a major role in diagnosis and enables appropriate management. Ultrasonography accurately demonstrates anatomic variations and pathologic conditions and is the initial modality of choice for detection of vascular and biliary lesions. Multidetector computed tomography and magnetic resonance imaging allow characterization and differentiation of various masses in the porta hepatis. Imaging-guided interventions, including embolization and stent placement, also play a key role in disease management.
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Affiliation(s)
- Sree Harsha Tirumani
- From the Department of Imaging, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.H.T.); Department of Radiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Tex (A.K.P.S.); Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Tex (R.V., S.R.P.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.O.M.)
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Hong HP, Seo TS, Cha IH, Yu JR, Mok YJ, Oh JH, Kwon SH, Kim SS, Kim SK. Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Korean J Radiol 2013; 14:789-96. [PMID: 24043974 PMCID: PMC3772260 DOI: 10.3348/kjr.2013.14.5.789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 06/11/2013] [Indexed: 12/29/2022] Open
Abstract
Objective To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Materials and Methods Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. Results The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Conclusion Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.
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Affiliation(s)
- Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, Korea. ; Department of Radiology, Kangwon National University College of Medicine, Chuncheon 200-722, Korea
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Ba-Ssalamah A, Bastati N, Uffmann M, Pretterklieber M, Schima W. [Peritoneum and mesenterium. Radiological anatomy and extent of peritoneal diseases]. Radiologe 2009; 49:543-54; quiz 555-6. [PMID: 19241053 DOI: 10.1007/s00117-008-1769-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The abdominal cavity is subdivided into the peritoneal cavity, lined by the parietal peritoneum, and the extraperitoneal space. It extends from the diaphragm to the pelvic floor. The visceral peritoneum covers the intraperitoneal organs and part of the pelvic organs. The parietal and visceral layers of the peritoneum are in sliding contact; the potential space between them is called the peritoneal cavity and is a part of the embryologic abdominal cavity or primitive coelomic duct. To understand the complex anatomical construction of the different variants of plicae and recesses of the peritoneum, an appreciation of the embryologic development of the peritoneal cavity is crucial. This knowledge reflects the understanding of the peritoneal anatomy, deep knowledge of which is very important in determining the cause and extent of peritoneal diseases as well as in decision making when choosing the appropriate therapeutic approach, whether surgery, conservative treatment, or interventional radiology.
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Affiliation(s)
- A Ba-Ssalamah
- Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090, Wien, Osterreich.
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Tani C, Nosaka S, Masaki H, Kuroda T, Honna T. Spontaneous perforation of choledochal cyst: a case with unusual distribution of fluid in the retroperitoneal space. Pediatr Radiol 2009; 39:629-31. [PMID: 19241071 DOI: 10.1007/s00247-009-1189-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 01/20/2009] [Accepted: 01/30/2009] [Indexed: 11/24/2022]
Abstract
Images of perforated choledochal cysts typically show an intraperitoneal fluid collection. We report a case with, in addition to free intraperitoneal fluid, fluid collection in the right-side anterior pararenal and perirenal spaces. Surgery confirmed the presence of a perforation at the junction of the cystic duct and the common bile duct. This perforation may explain the biliary leakage extending into the free peritoneal space as well as into the anterior pararenal space and the hepatoduodenal ligament. Anterior pararenal and perirenal spaces communicate with the infrarenal space, and this may result in extension of the fluid into the perirenal space from the anterior pararenal space.
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Affiliation(s)
- Chihiro Tani
- Department of Radiology, Graduate School of Medicine, University of Hiroshima, Minami-ku, Hiroshima, Japan.
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Grassi R, de Rosa R, Greco M, Maggialetti A, Maiorano M, Cappabianca S. Blunt trauma of the hepatogastric ligament: a case-report. THE JOURNAL OF TRAUMA 2004; 56:428-30. [PMID: 14960989 DOI: 10.1097/01.ta.0000028836.78679.c6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Roberto Grassi
- Istituto di Scienze Radiologiche II Università, Naples, Italy
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Miyayama S, Matsui O, Akakura Y, Yamamoto T, Nishida H, Minami T, Kozaka K, Tawaraya K, Kasahara Y. Percutaneous cholecystocholedochostomy for cholecystitis and cystic duct obstruction in gallbladder carcinoma. J Vasc Interv Radiol 2003; 14:261-3. [PMID: 12582196 DOI: 10.1097/01.rvi.0000058330.82956.8a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Percutaneous cholecystocholedochostomy was performed in a patient with acute cholecystitis caused by cystic duct obstruction by gallbladder carcinoma, but removal of the percutaneous cholecystostomy catheter was unsuccessful because of continuing discharge. After creation of a cholecystocholedochostomy through the cholecystostomy tract with use of a transjugular liver access set and a 21-gauge needle, self-expandable metallic stents were placed in the narrowed common bile duct and the newly created tract between the gallbladder and the common hepatic duct. The external cholecystostomy catheter was successfully removed after the procedure. Jaundice occurred 70 days later as a result of tumor invasion above the segment with the stent, and an additional stent was placed. The patient died of diffuse metastasis 143 days after creation of the cholecystocholedochostomy without recurrence of cholecystitis.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology,Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
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Francis IR, Marn CS. Isolated portacaval adenopathy in Hodgkin lymphoma. CT and US findings. Clin Imaging 1994; 18:28-30. [PMID: 8180856 DOI: 10.1016/0899-7071(94)90142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a case of isolated portacaval adenopathy as the initial presenting feature in a patient with Hodgkin lymphoma. The differential diagnosis of masses located in the portacaval space is discussed and signs useful to localized tumors to this space are described.
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Affiliation(s)
- I R Francis
- Department of Diagnostic Radiology, University of Michigan Hospitals, Ann Arbor 48109-0030
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Silverman PM, Feuerstein IM, Garra BS, Zeman RK. Evaluation of STIR imaging as a complement to spin-echo MR and CT of the porta hepatis/hepatoduodenal ligament. Magn Reson Imaging 1991; 9:73-7. [PMID: 2056854 DOI: 10.1016/0730-725x(91)90099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Short TI inversion-recovery (STIR) imaging provides specific advantages over standard spin-echo (SE) MR sequences by producing additive effects of T1 and T2 brightening of pathology and suppression of the signal from surrounding fat. We retrospectively evaluated 12 patients with abnormalities, primarily neoplastic, of the porta hepatis/hepatoduodenal ligament (PH/HdL) with CT and MR imaging, including SE and STIR imaging. Masses on CT were of slightly decreased density compared to liver and seen in contrast to surrounding fat in the PH/HdL region. On MR, T1-weighted images provided comparable anatomic detail to CT, with masses clearly distinguished from surrounding fat due to the low signal intensity of masses as compared to fat. T2-weighted images clearly depicted intrahepatic lesions because of their high signal intensity relative to liver. Increased signal in extrahepatic lesions made them less distinctly seen from surrounding fat. STIR images best demonstrated tumor relative to fat. In six cases, CT was equivalent in demonstrating pathology to the best MR sequence. At least one MR sequence demonstrated pathology better than CT in 6 of 12 cases. In five of these six cases, the STIR sequence was better than CT. Thus, MR, particularly STIR imaging, provides a useful technique in imaging of PH/HdL pathology.
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Affiliation(s)
- P M Silverman
- Department of Radiology, Georgetown University Hospital, Washington, D.C. 20007
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Abstract
Over the past several years, abdominal single photon emission computed tomography (SPECT) imaging has evolved from a research tool to an important clinical imaging modality that is helpful in the diagnostic assessment of a wide variety of disorders involving the abdominal viscera. Although liver-spleen imaging is the most popular of the abdominal SPECT procedures, blood pool imaging is becoming much more widely utilized for the evaluation of cavernous hemangiomas of the liver as well as other vascular abnormalities in the abdomen. Adjunctive indium leukocyte and gallium SPECT studies are also proving to be of value in the assessment of a variety of infectious and neoplastic diseases. As more experience is acquired in this area, SPECT should become the primary imaging modality for both gallium and indium white blood cells in many institutions. Renal SPECT, on the other hand, has only recently been used as a clinical imaging modality for the assessment of such parameters as renal depth and volume. The exact role of renal SPECT as a clinical tool is, therefore, yet to be determined.
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