Are Hepatic Portal Venous System Components Distributed Equally in the Liver? A Multidetector Computerized Tomography Study

İncedayı, Mehmet; Arıbal, Serkan; Sivrioğlu, Ali Kemal; Sönmez, Güner; Öztürk, Ersin; Yalçın, Bülent; Başekim, Cihad Çınar

doi:10.5152/balkanmedj.2012.050

Cited by 8 publications

(3 citation statements)

References 8 publications

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“…As a human study, Moore and Bridenbaugh [ 7 ] performed portal venography and suggested that streamline flow exists, based on the finding that the SV flows mainly into the left lobe of the liver, whereas the SMV flows mainly into the right. In 2012, a study calculating the diameters of the main venous structures also suggested the existence of streamline flow [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival

et al. 2017

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PurposeIt is believed that blood from the superior mesenteric vein and splenic vein mixes incompletely in the portal vein and maintains a streamline flow influencing its anatomic distribution. Although several experimental studies have demonstrated the existence of streamlining, clinical studies have shown conflicting results. We investigated whether streamlining of portal vein affects the lobar distribution of colorectal liver metastases and estimated its impact on survival.MethodsData of patients who underwent hepatectomy for colorectal liver metastases were retrospectively collected. The chi-square test was used for analyzing the distribution of metastasis. Cox analysis was used to identify risk factors of survival. Fisher exact test was used for subgroup analysis comparing hepatic recurrence.ResultsA total of 410 patients were included. The right-to-left ratio of liver metastases were 2.20:1 in right-sided colon cancer and 1.39:1 in left-sided cancer (P = 0.017). Cox analyses showed that margin < 5 mm (P < 0.001; 95% confidence interval [CI], 1.648–4.884; hazard ratio [HR], 2.837), age ≥ 60 years (P = 0.004; 95% CI, 1.269–3.641; HR, 2.149), N2 status (P < 0.001, 95% CI, 1.598–4.215; HR, 2.595), tumor size ≥ 45 mm (P = 0.014; 95% CI, 1.159–3.758; HR, 2.087) and other metastasis (P = 0.012; 95% CI, 1.250–5.927; HR, 2.722) were risk factors of survival. However, in 70 patients who underwent right hemihepatectomy for solitary metastasis, left-sided colorectal cancer was a risk factor (P = 0.019; 95% CI, 1.293–17.956; HR, 4.818), and was associated with higher recurrence than right-sided cancer (43.1% and 15.8%, respectively, P = 0.049).ConclusionThis study showed significant difference in lobar distribution of liver metastases between right colon cancer and left colorecral cancer. Furthermore, survival of left-sided colorectal cancer was poorer than that of right-sided cancer in patients who underwent right hemihepatectomy for solitary metastasis. These findings can be helpful for clinicians planning treatment strategy.

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Section: Introductionmentioning

confidence: 99%

Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival

et al. 2017

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“…The most common route of bacterial seeding to the liver is hematogenous spread via the portal circulation. The right lobe in particular is involved in 72% of hepatic abscesses [ 6 ] as it receives the majority of portal circulation [ 9 , 10 ]. The intestinal microorganisms are able to cross the gut-vascular barrier and enter the venous circulation either via various virulence factors [ 11 ], or via intestinal perforations [ 12 ] similar to those caused by diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

et al. 2017

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BackgroundPatients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature.Case PresentationA 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the fistula and abscess had entirely resolved.ConclusionsRefractory right-sided pleural effusion combined with constitutional symptoms should alert clinicians to search for possible hepatic abscess, especially in the context of diverticulitis. The rupture of an untreated hepatic abscess could lead to death from profound sepsis or rarely, as in this case, a hepato-bronchial fistula. Timely investigation and a multidisciplinary treatment approach can lead to improved patient outcomes.

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“…SpV blood flow is seen to uniformly opacify the MPV, which is in line with studies suggesting equal distribution of SpV blood between the right and left lobes. However, SMV flow is streamlined within the MPV in keeping with its preferential flow into the right lobe in many patients (Figure 2A) (11,23,35).…”

Section: Cbct Evaluation Of Individual Drainage Systemsmentioning

confidence: 99%

Utility of cone-beam computed tomography in the assessment of the porto-spleno-mesenteric venous system

Karuppasamy

2016

Cardiovasc. Diagn. Ther.

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The common diagnostic tools available to evaluate the porto-spleno-mesenteric venous (PSMV) system provide either good hemodynamic information with limited morphological details [e.g., ultrasonography (US)] or excellent tomographic display of the anatomy with limited information about flow patterns [e.g., multidetector computed tomography (MDCT) and magnetic resonance imaging]. Although catheter-directed selective digital subtraction angiography (DSA) can provide excellent information about flow at a high temporal resolution and can generate images at a high spatial resolution, this technique is often limited by a lack of cross-sectional detail. In the assessment of the PSMV system, DSA is also limited by dilution of contrast and motion artefacts. Combining venous phase cone-beam computed tomography (CBCT) with DSA can generate high-quality tomographic data, which allows detailed evaluation of venous tributaries and flow patterns within the splenic, superior mesenteric, and inferior mesenteric venous systems individually. This enables clinicians to better understand the impact of nonobstructive resistance to flow (e.g., as in patients with cirrhosis) and obstructive resistance to flow (e.g., as in patients with thrombosis) within each system and plan treatment accordingly. In this review, we discuss the limitations of common diagnostic methods and the role venous CBCT in combination with DSA can play in assessing the PSMV system.

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Are Hepatic Portal Venous System Components Distributed Equally in the Liver? A Multidetector Computerized Tomography Study

Cited by 8 publications

References 8 publications

Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival

Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

Utility of cone-beam computed tomography in the assessment of the porto-spleno-mesenteric venous system

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