Hepatic Vasculature

Hepatic Vasculature Technique Summary

Vessel Image Plane Technique LHV Transverse / Longitudinal Locate the left lobe of the liver. Identify the inferior vena cava and angle steeply towards the diaphragm. The LHV and MHV should be seen as they drain into the IVC. LPV Transverse, coronal, intercostals, decubitus Locate horizontal segment of PLV, adjust transducer to obtain steepest angle for Doppler (parallel to the vessel), and zoom in on the LPV LHA Transverse Usually found posterior to horizontal segment of LPV. After interrogating the PLV, look for LHA with color Doppler (expand color box to cover the LPV and adjacent liver tissue). Place PW cursor/ sample volume in area of LHA (suspend respiration); watch for "flashing" of signal as it comes in and out of view with respiration. Look for LHA on deep inspiration. If you can't get the signal in the periphery of the liver, move to another location closer to the main portal vein. Common HA Longitudinal - porta hepatis Use same technique as described for LHA   Transplant recipient patients: usually only able to Doppler HA at the porta hepatis Include extra-and intrahepatic segment of HA Difficult to image site of anastomosis MPV Longitudinal - porta hepatis If shunt is present, anastomosis site easier to identify (more prone to thrombosis); be sure to investigate the MPV proximal, within, and distal to anastomosis. IVC Longitudinal, coronal - slightly to right of midline; suspend breath. Angle transducer in cephalad to caudal sweep to record flow May be difficult to obtain good angle because of horizontal location on transverse plane. If shunt is present, evaluate site of anastomosis carefully (proximal, within, and distal) Look carefully for presence of internal echoes that represents thrombosis. If you suspect thrombus is present, and the Doppler signal is very "choppy" with high velocity and little phasicity, the likelihood of thrombus is good. Be sure to follow the IVC all the way into the right atrium of the heart. SV Transverse Evaluate SV from the splenic hilum to the portal-splenic confluence RHA Transverse, Anterior to right posterior portal branch. Use same techniques as mentioned to Doppler the RPV and RHA. If you are unable to locate the RHA in the periphery of the liver, move closer to the trunk of the adjacent PV. If you can't find the RHA at the right posterior portal branch, try looking for it at the level of the right anterior PV branch. RPV Anterior, intercostals approach; one rib space away from window for porta hepatis To locate right posterior branch of RPV, begin with the MPV at the porta hepatis Follow the MPV into the liver until you see the RPV. The posterior branch extends posteriorly into the right lobe. It is easier to obtain a good Doppler angle if you use a more anterior, intercostals approach. Make small movements with the probe to get into the right posterior portal branch. RHV Transverse, subcostal Place the probe just below the level of the xyphoid with a steep angulation toward the diaphragm. Locate the IVC; the RHV will be seen in the right lobe of the liver in a horizontal plane as it empties into the IVC. MHV Transverse, subcostal Place the probe just below the level of the xyphoid with a steep angulation toward the diaphragm. Locate the IVC; the MHV will be seen in a vertical plane as it separates the right lobe from the left lobe of the liver as it empties into the IVC.

Hepatic Vasculature

Hepatic Vasculature

Hepatic Vasculature

Hepatic Vasculature