No abstract available.
Hepatic Artery/*abnormalities ; Humans ; Male ; *Pancreatic Ducts

Descriptions of the variant hepatic arterial pattern are common and frequently reported in anatomy archives. We describe a noteworthy deviation from the usual branching pattern in a single cadaver. There was a unique division of the hepatic artery proper into two right gastric arteries (RGAs), apart from the usual branches. Furthermore, an arterial loop was formed by these two RGAs, giving off another RGA, which we termed 'right gastric proper'. This report attempts to evaluate the embryological basis of the anomaly. The significance of this anomalous hepatic arterial pattern is appreciated while performing liver transplantations, hepatic artery infusion of chemotherapeutic drugs and Doppler angiographic procedures. We advocate meticulous familiarisation with the anatomy of the coeliac trunk and its topographic relationship to vital viscera for the operating hepatobiliary surgeon and radiologist.
Adult ; Cadaver ; Hepatic Artery ; abnormalities ; Humans ; Male ; Stomach ; abnormalities ; blood supply

Various benign and malignant conditions can cause biliary obstruction. We present a rare case of obstructive jaundice due to the compression of the common hepatic duct by the anteriorly overriding right hepatic artery. This case was also associated with the absence of the lateral segment of the left hepatic lobe. The patient was a 39 year-old housewife with a 4-day history of jaundice and occasional febrile sensation. An abdominal computed tomography showed absence of the lateral segment of the left hepatic lobe and a percutaneous transhepatic cholangiography showed a band-like filling defect of 2 mm width at the level of the upper common hepatic duct. The anteriorly overriding right hepatic artery compressing the common hepatic duct and the absence of the lateral segment of the left hepatic lobe were confirmed by operation.
Adult ; Bile Duct Diseases/complications ; Case Report ; Cholestasis/*etiology ; Female ; *Hepatic Artery ; *Hepatic Duct, Common ; Human ; Liver/*abnormalities

Angiography ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo study the principle and surgical managements for the patients with anatomic variants of hepatic artery in the procedure of pancreaticoduodenectomy (PD).

METHODSOne hundred and seventy-six patients who underwent PD between January 2000 and July 2007 were investigated retrospectively. Hepatic arterial variants were analyzed according to the intraoperative finding and CT imaging were reviewed postoperatively.

RESULTSHepatic arterial variants were found intraoperatively in 20 cases of all 176 patients. Accessory right heptic artery, replaced right heptic artery and common heptic artery arising from the superior mesenteric artery (SMA) were present in 9 (5.1%), 5 (2.8%), 4 (2.3%) cases respectively,and replaced right heptic artery coming from the gastroduodenal artery was present in 2 cases (2.9%). All the variants of hepatic arteries arising from the superior mesenteric artery could be observed in spiral CT imaging. Most of the variant arteries were dissected intact intraoperatively except 2 cases with accessory right heptic artery arising from SMA.

CONCLUSIONSPerforming CT scan preoperatively, especially CTA,is effective to diagnose these disorders. Skillful surgical techniques can manage the anatomic variants safely.

Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Radiography ; Retrospective Studies

Focal fatty change of the liver is a nodular lesion which is a rarely described and poorly characterized entity. The hepatic nodule measured 1.4cm at its maximum diameter, was subcapsular in location and occurred adjacent to the falciform ligament. Microscopically it was composed of hepatic tissue with a preserved lobular architecture. The central venous structures and portal tracts with their triads were regularly placed. The cytoplasm of almost all of the hepatocytes within the nodule was replaced by macrovesicular fat vacuoles with the nuclei displaced. Several large abnormal vessels were found at the margin of the nodule. The nodule was discovered incidentally on postmortem examination of a female infant who proved, at autopsy, to have multiple cardiac anomalies and bronchopneumonia. The possible inadequate local tissue perfusion due to abnormal intrahepatic vessels at this particular location could be augmented by multiple cardiac anomalies culminating in focal ischemia and focal fatty change. When encountered in surgery or on gross examination, it could be confused with other space occupying lesions such as liver cell adenoma, abscess and metastatic lesions.
Fatty Liver/complications ; Fatty Liver/pathology* ; Female ; Heart Defects, Congenital/complications ; Hepatic Artery/abnormalities ; Human ; Infant

Adult ; Aged ; Arteriovenous Fistula ; etiology ; Carcinoma, Hepatocellular ; complications ; Female ; Hepatic Artery ; abnormalities ; Hepatic Veins ; abnormalities ; Humans ; Liver Neoplasms ; complications ; Male ; Middle Aged

Adult ; Aged ; Arteriovenous Fistula ; complications ; diagnostic imaging ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; Hepatic Veins ; abnormalities ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

OBJECTIVETo explore the application value of the MI-3DVS in patients with hepatic artery variation receiving duodenopancreatectomy.

METHODSA total of 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed during January 2010 to July 2012. The clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional reconstruction. Based on the reconstructed 3-dimensional model, the origination and bifurcations of variant hepatic artery was observed. And its anatomical relationships with abdominal organs and vessels were also observed. Thereafter, preoperative procedures planning was formulated. The findings were compared to those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery.

RESULTSThe abdominal 3D models can clearly display the size and shape of tumor, the origin and course of the blood vessels, as well as the 3D anatomic relationship between tumors and organs, blood vessels. A total of 14 cases (12.3%, 14/114) were found with variant, including 9 cases (7.9%) with replaced right hepatic artery arising from superior mesenteric artery, 3 cases (2.6%) with replaced common hepatic artery arising from superior mesenteric artery, 2 cases (1.8%) with replaced left hepatic artery arising from left gastric artery. The 14 patients all received standard procedures of duodenopancreatectomy. Compared to the intraoperative findings and postoperative DSA examination, the sensitivity, specificity and accuracy of MI-3DVS to variant hepatic artery is 100%. The preoperative planning guided by MI-3DVS is in line with the intraoperative findings.No postoperative complications occurred in all 14 patients, including hepatic abscesses, biliary fistula and liver failure.

CONCLUSIONSMI-3DVS can accurately diagnose hepatic artery variation before duodenopancreatectomy. Therefore, it contributes to the formulation of preoperative surgical plans.It also increases the success rate of the surgical operations and decreases the occurrence of postoperative complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Hepatic Artery ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pancreaticoduodenectomy ; instrumentation ; Retrospective Studies ; Tomography, Spiral Computed ; Young Adult

OBJECTIVETo evaluate the capability of multidetector CT (MDCT) for the diagnosis of arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC).

METHODSTwo hundred and eighty-two patients with HCC were examined by both enhanced thin slice MDCT scanning in early hepatic arterial phase, late hepatic arterial phase, portal venous phase and digital subtraction angiography (DSA). The criteria for diagnosis of APS: (1) Earlier enhancement or stronger opacification of main portal trunk and/or the first order branches compared with that of superior mesenteric vein or splenic vein; (2) Earlier enhancement or stronger opacification of the second order and smaller portal venous branches compared with that of main portal trunk. The presence and degree of APS demonstrated with MDCT and DSA were analysed by double blind method.

RESULTSIn 282 HCC patients, 56 were complicated with APS. MDCT demonstrated central APS in 48 patients with 41 severe and 7 moderate shunt, one revealing no APS by DSA due to the giant HCC focus. Among 7 patients with light peripheral APS, two lesions were not revealed by DSA due to faint shunt and the last lesion in the patient with mixed APS was revealed both by APS and DSA.

CONCLUSIONMultidetector CT was a simple, effective and noninvasive new technique for the diagnosis of arterioportal shunt associated with hepatocellular carcinoma.

Adult ; Aged ; Angiography, Digital Subtraction ; Arteriovenous Fistula ; diagnostic imaging ; etiology ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; abnormalities ; diagnostic imaging ; Tomography, Spiral Computed ; methods