Imaging of the Porta Hepatis: Spectrum of Disease

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.

“Periportal neoplasms”—a CT perspective: review article

“…[1][2][3] Primary periportal neoplasm Cholangiocarcinoma Cholangiocarcinoma (CCA) is one of the commonest malignancies of the biliary tract, ranking next only to carcinoma gall bladder in incidence. The average age of presentation is 50 years, with a slight female preponderance.…”

“…1,12,13 Lymphoma as a part of the spectrum of post-transplant lymphoproliferative disorders (PTLD) seen in the transplant recipients are usually extranodal, the liver being the commonest solid visceral organ to be involved. Three imaging patterns in PTLD of the liver have been described-poorly enhancing circumscribed masses, diffusely infiltrating pattern and an uncommon periportal infiltrating lesion.…”

Karaciğerin Mezenkimal Tümörleri

“…Karaciğer nörofibromları çok nadir gözle-nen tümörler olup çoğunlukla jeneralize abdominal ve retroperitoneal tutulumda gözlenir [17][18][19]. BT incelemede düşük dansiteli, T1A görüntülerde düşük sinyal intensiteli ve T2A görüntülerde yüksek sinyal intensiteli lezyonlar olarak gözlenirler [17].…”

“…BT incelemede düşük dansiteli, T1A görüntülerde düşük sinyal intensiteli ve T2A görüntülerde yüksek sinyal intensiteli lezyonlar olarak gözlenirler [17]. Periferal yerleşimli nörofibromlar T2A görüntülerde nodüler, santral kesimi hipointens lezyonlar olarak gözlenir [17,18].…”

“…Periportal kılıf boyunca yayılım nörofibrom-ların tipik yayılım şekli olup lezyonun intrahepatik sinir fiberleri trasesi boyunca yayıldığını gösteren değerli bir bulgudur [17,18]. Periportal infiltrasyon çölyak ganglion ve ötesine yayılırsa retroperitoneal nörofibrom gibi yanlış tanılara sebep olabilir.…”