Hepatic lymphatics: anatomy and related diseases

Abstract

The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size.

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

“…This periportal hepatic lymph flows in the same direction as bile, and 80 % or more of hepatic lymph drains through this periportal lymphatic system [26,28]. The efferent lymphatic vessels outside the liver communicate with hilar LNs and peripancreatic LNs and act as the first LN station [24,25,27]. Hilar LNs are connected with celiac LNs or juxtaesophageal and gastrocardiac LNs along the lesser omentum, and peripancreatic LNs reach the superior mesenteric LNs.…”

“…However, both regional and distant LN metastases are likely to have occurred via multidirectional lymphatic outflow from the liver [24]. Although most hepatic lymph may flow into those regional lymph nodes in the hilar region along the portal triads, there are also several lymphatic outflows directly connected with distant areas of the general lymphatic system [25].…”

Idiopatik Periportal Lenfadenopati

“…Periportal lenfadenopati karaciğer, safra yolları, pankreas, gastointestinal sistem (GİS) kanserleri ve lenfoma durumlarında görüntüleme metodlarında sıklıkla gözlenir ve evreleme-tedavi açısından öneme haizdir (2). Fakat, Türkçe ve İngilizce dilinde literatür taramımızda, bu kanserler haricinde periportal lenf nodunun önemiyle ilgili çalışma sayısı çok azdır.…”

Imaging of pathology involving the space around the hepatic veins: "perivenous pattern"

“…The hepatic lymphatic system is mainly divided into superficial and deep networks (7). The deep hepatic lymphatic system mainly surrounds the portal vein branches and is responsible for 80% of the lymphatic drainage of the liver (8).…”

“…As mentioned above, despite the fact that the periportal compartment is where the main deep lymphatic network is located, a not insignificant portion of the deep drainage is via the perivenous lymphatic vessels which mainly reside around the hepatic veins. The perivenous lymphatic vessels finally converge into 5-6 large vessels which eventually drain into posterior mediastinal lymph nodes (7).…”