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Hepatic Vasculature Review

Venous System

LT Portal Vein

RT Portal Vein

Main Portal Vein

Splenic Vein

LT Hepatic Vein

RT Hepatic Vein

Middle Hepatic Vein

  • drains the spleen, pancreas, and stomach
  • courses posterior to the body of the pancreas
  • unites with SMV to form the main portal vein
  • hepatopetal
    • color doppler will depend on transducer and vessel position

Splenic Vein

Hepatopedal

Hepatofugal

  • provide 75% of blood flow to the liver
  • drains nutrient rich blood from the intestines, spleen, stomach, gallbladder, and pancreas
  • transversely oriented and intrasegmental
  • formed by the SMV, IMV, and splenic vein
  • converge at porta hepatis
  • enlarge as they approach the porta hepatis
  • surrounded by an echogenic fibrous sheath
  • monophasic and unidirectional

Portal Veins

  • Longitudinally oriented and intersegmental
  • RT, middle, and LT converge into the IVC at the diaphragm to drain blood from the liver
  • largest tributaries of the IVC
  • enlarge toward the diaphragm
  • pulsatile, triphasic, and bidirectional

Hepatic Veins

Hepatic Veins vs. Portal Veins

Splenic Vein

Venous System Normal Waveforms

Portal Venous System

Hepatic Veins

  • empties into the right atrium
  • changes in size with respiration
Normal Spectral Doppler:
  • pulsatile at proximal
  • phasic, spontaneous at distal
Abnormal Spectral Doppler:
  • continuous signal

IVC

Normal Flow

  • supply blood to the spleen
  • branch of the celiac trunk
  • runs superior to the pancreas
  • tortuous and typically turbulent

Arterial System

Common Hepatic Artery

  • follows the portal vein and CBD
  • within the liver it divides into right and left hepatic arteries to supply blood to the liver
  • low resistive waveform
  • normal RI ranges from 0.5-0.7
  • hepatopedal
  • branch off the celiac artery
  • gives rise to the GDA and turns into proper hepatic artery

Splenic Artery

Proper Hepatic Artery

Variants

Arteries:

  • common or right hepatic artery may arise from the SMA
  • common or right hepatic artery may arise off the aorta
  • left hepatic artery may arise from the left gastric artery
Veins:
  • middle and left hepatic vein may join to form a common trunk before entering the IVC
  • a hepatic vein may be absent
    • right more commonly absent
  • left hepatic frequently duplicated

Hepatic Anomalies

replaced: a vessel arises from an anomalous origin and supplies a portion of the liver solely Two most common variants: replaced right hepatic artery = right hepatic artery arising from the SMA Replaced left hepatic artery = left hepatic artery arising from the left gastric artery

Replaced Hepatic Artery

https://www.wjgnet.com/1007-9327/full/v28/i19/2057.htmhttps://radiopaedia.org/images/4708936?case_id=24894 https://www.swissnephro.org/blog/2016/3/10/liver-doppler-ultrasound-increased-pulsatility-in-portal-vein-flow https://thoracickey.com/ultrasound-of-the-hepatoportal-circulation/ https://radiologykey.com/hepatobiliary-ultrasound/

Resources

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