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Imaging and Intervention in the Hepatic Veins

Terry S. Desser1, Daniel Y. Sze and R. Brooke Jeffrey

1 All authors: Department of Radiology, Stanford University School of Medicine, Mail Code 5621, 300 Pasteur Dr., Stanford, CA 94305.



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  		Fig. 1. —Normal hepatic venous anatomy. Drawing shows major hepatic veins and short hepatic vein orifices.

 


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  		Fig. 2. —41-year-old healthy male volunteer. Transverse sonogram shows inferior right hepatic vein (arrow) joining inferior vena cava posterior to right portal vein.

 


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  		Fig. 3. —Schematic representation shows temporal events of cardiac cycle (EKG) and their relationship to central venous pressure (CVP) tracing and hepatic venous (HV) velocity waveform. Opening and closing of tricuspid valve are indicated.

 


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  		Fig. 4. —Duplex Doppler sonogram of normal triphasic hepatic venous tracing of 43-year-old woman.

 


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  		Fig. 5. —84-year-old woman referred for evaluation of lower extremity edema. Contrast-enhanced portal venous phase CT scan shows portal vein–hepatic vein shunt. Hepatic vein tributary (white arrow) connects to left portal vein (arrowhead) via small vascular malformation (black arrow).

 


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  		Fig. 6. —42-year-old woman with suspected intraabdominal abscess. Contrast-enhanced portal venous phase CT scan shows reticular or mosaic perfusion of liver similar to pattern in Budd-Chiari syndrome. At autopsy, patient had severe ischemic cardiomyopathy and hepatic congestion.

 


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  		Fig. 7. —74-year-old woman with liver abscess (not shown). CT scan shows thrombus (arrow) in right hepatic vein.

 


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  		Fig. 8. —88-year-old man with hepatocellular carcinoma. CT scan shows tumor thrombus invading and expanding right hepatic vein (white arrow) and inferior vena cava (black arrow).

 


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  		Fig. 9A. —40-year-old woman with Budd-Chiari syndrome. Transverse color Doppler sonogram obtained at level of caudate lobe shows numerous intrahepatic collateral vessels (arrows).

 


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  		Fig. 9B. —40-year-old woman with Budd-Chiari syndrome. CT scan obtained at same level as A shows characteristic appearance of Budd-Chiari syndrome, with increased central hepatic enhancement and decreased enhancement of liver periphery.

 


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  		Fig. 10A. —60-year-old man with liver dysfunction after orthotopic liver transplantation 2 years earlier. Duplex sonogram of right hepatic vein shows low-velocity undulating monophasic waveform suggestive of venous outflow obstruction.

 


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  		Fig. 10B. —60-year-old man with liver dysfunction after orthotopic liver transplantation 2 years earlier. Percutaneous transhepatic venogram shows near occlusion at anastomosis, with stasis of flow. Pressure gradient was 14 mm Hg.

 


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  		Fig. 10C. —60-year-old man with liver dysfunction after orthotopic liver transplantation 2 years earlier. Venogram obtained from above piggyback anastomosis shows tapered occlusion.

 


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  		Fig. 10D. —60-year-old man with liver dysfunction after orthotopic liver transplantation 2 years earlier. Final venogram obtained after stent placement shows rapid passage of contrast material from hepatic vein into inferior vena cava and right atrium.

 


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  		Fig. 11. —45-year-old woman with ulcerative proctitis and Budd-Chiari syndrome. Contrast-enhanced CT scan shows heterogeneous hepatic enhancement, with relatively increased enhancement in pericaval region. Transjugular intrahepatic portosystemic shunt (arrow) was placed from stump of right hepatic vein to right portal vein for treatment of portal hypertension.

 


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  		Fig. 12A. —20-year-old man with Budd-Chiari syndrome with portosystemic collaterals. Contrast-enhanced portal venous phase CT scan obtained at dome of liver shows thrombosed hepatic veins (arrows). Esophageal varices (arrowhead) are present.

 


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  		Fig. 12B. —20-year-old man with Budd-Chiari syndrome with portosystemic collaterals. Portal venous phase CT scan obtained inferior to A shows pericaval intrahepatic collaterals (white arrow) and dilated paraumbilical vein (black arrow).

 


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  		Fig. 13A. —23-year-old woman with acute myelogenous leukemia and sinusoidal obstruction syndrome (hepatic venoocclusive disease) after bone marrow transplantation. Duplex Doppler sonogram shows low-velocity monophasic flow in middle hepatic vein.

 


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  		Fig. 13B. —23-year-old woman with acute myelogenous leukemia and sinusoidal obstruction syndrome (hepatic venoocclusive disease) after bone marrow transplantation. Contrast-enhanced CT scan shows heterogeneous hepatic enhancement and low attenuation adjacent to patent right hepatic vein and inferior vena cava, presumably representing lymphedema.

 


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  		Fig. 14A. —34-year-old woman with focal nodular hyperplasia. Transverse sonogram shows isoechoic mass near confluence of right hepatic vein and inferior vena cava.

 


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  		Fig. 14B. —34-year-old woman with focal nodular hyperplasia. Duplex Doppler sonogram shows low-velocity monophasic right hepatic venous waveform.

 

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