Where is hepatic portal vein

This differentiation is crucial because patients with OPV usually have preserved liver function, and patient management differs from other causes of PH. OPV imaging findings comprise the similar signs described for other general causes of PH but the most useful features are the disparity in caliber from the central PV branches increased and its first and second order segmental branches clearly reduced or even not detectable Fig.

Nodular regenerative hyperplasia focal nodular hiperplasia-like nodules and perfusion disorders are also more frequent in cases of OPV than in cirrhosis. Considering the differential diagnosis, it should also be noted that the combination of hypertrophy of the caudate lobe, atrophy of segment IV, and a nodular liver surface are signs more often associated whit true cirrhosis but not with OPV.

Obliterative portal venopathy. Axial a plain, b arterial, and c portal venous phase contrast-enhanced CT images show some morphologic liver changes, with hypertrophy of the caudate lobe, but regular contours and no atrophy of segment IV. Right PV is hypoattenuating before and after contrast material administration yellow arrows , a feature suggesting non-acute thrombus.

Hepatic parenchyma displays heterogeneous peripheral enhancement in arterial phase b due to compensatory increased arterial flow. This THED fades in portal venous phase c. Some PH stigmata are present, as such splenomegaly, permeable umbilical vein red arrow , and other varices. Liver biopsy was performed and OPV diagnosis pathologically confirmed.

Despite the PH etiology, acquired extrahepatic portosystemic shunts may develop over time in an attempt to reduce the hepatofugal venous flow discussed below. Acquired extrahepatic portosystemic shunts are the most common shunts among PVS. A large group of pathologies can trigger its development, but the most common cause is PH [ 2 , 15 ].

Other causes include splenic, splenomesenteric, and SMV stenosis or obstruction. Hepatopetal venous flow is rerouted away from the liver hepatofugal through collateral pathways to reach the low-pressure systemic vessels. The imaging findings are the presence of dilated tortuous veins in relation with the PVS and systemic venous system.

Can be found on ultrasound, on CT are best depict at portal venous phase as tubular enhancing structures and on MRI as flow voids. Coronary collateral veins at the lesser omentum are the most frequently depicted varices [ 5 ] Fig. Their presence has a high sensitivity rate to PH diagnosis.

Gastric varices are commonly located in the posterosuperior aspect of the gastric fundus Fig. Esophageal varices are of major clinical importance because they are a frequent source of gastrointestinal bleeding Fig. Endoscopy is more sensitive in the diagnosis of esophageal mucosal varices but CT shows to better advantage the paraesophageal varices. Both venous plexuses communicate via perforating veins, crossing the muscular layer of the esophageal wall.

Esophageal and paraesophageal varices. Portal venous phase CT axial images show paraesophageal varices red arrow in the mediastinum, appearing as dilated tortuous veins surrounding the outer surface of the esophageal inferior third green arrow , and esophageal varices blue arrow , presenting as submucosal varicose veins within the esophagus wall.

Paraumbilical vessels are an accepted pathway to decompress the PVS because they are not associated with gastrointestinal bleeding. The most common drainage pattern of paraumbilical veins is through the epigastric veins into the external iliac veins Fig. Collateral vessels draining into the left renal vein are fairly common, and they are not associated with gastrointestinal bleeding either. However, enlarged shunts are associated with hepatic encephalopathy.

Gastrorenal shunt. MPR image from portal venous phase CT at the level of the left kidney shows a tortuous and high-caliber gastrorenal shunt, running from gastric varices to the left renal vein. Note the increased diameter of the left renal vein downstream shunt confluence, compared to the normal sized left renal vein segment upstream.

Inferior mesenteric collateral vessels are less frequent but of great importance because of their association with rectal bleeding, since the PVS superior hemorrhoidal vein and the systemic venous circulation middle and inferior hemorrhoidal veins connect via the hemorrhoidal plexus Fig. Portal venous phase CT images showing a variceal network along, around and within the anorectal wall. In this case, we can individualize ingurgitated tortuous vessels red arrows , but sometimes thickening and hyperenhancement are all we can see.

Mesocaval shunts are portosystemic collateral vessels between the SMV and IVC that are established through retroperitoneal veins, and are not associated with an increased risk of rectal bleeding Fig. Retroperitoneal varices. VRT image from portal venous phase CT shows an increase in size of SV green arrow and SMV red arrow , an extensive collateral network of varices fed by SMV blue arrows , communicating with a huge-caliber right ovarian vein yellow arrow , and giving rise to varices along the ovarian venous plexus.

Acquired intrahepatic portosystemic shunt can result from trauma, PH, and in the setting of transjugular intrahepatic portosystemic shunt TIPS. The creation of a TIPS in the context of PH is one of the most common percutaneous interventional procedures involving PVS, where a parenchymal channel between a large hepatic vein and a major PV branch is created by inserting an expandable stent, in most cases connecting the right PV with the right or middle hepatic vein Fig.

Transjugular intrahepatic portosystemic shunt. Note enlargement of the hepatic vein due to increased flow directly drained from the PVS to its lumen, skipping the hepatic parenchyma. Other iatrogenic findings may result from post-surgical changes. Liver surgery mainly consists in anatomical-oriented resections, based on the intrahepatic distribution of portal branches and hepatic veins [ 19 ]. Liver surgery. MIP image from portal venous phase CT shows right hepatectomy findings: section and ligation of the right PV at its origin; shift of left liver toward the right with horizontalization of PV; prominent caliber of left PV and hypertrophy and rounded contours of the remaining liver.

Understanding the embryology, normal anatomy, and anatomical variants of the PVS is important to accurately interpret abdominal findings. Knowledge of typical features of congenital and acquired PV pathologies allows the radiologist to make a confident diagnosis potentially impacting patient management. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

National Center for Biotechnology Information , U. Journal List Insights Imaging v. Insights Imaging. Published online Mar Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Nov 7; Accepted Feb 4. This article has been cited by other articles in PMC. Abstract The portal vein PV is the main vessel of the portal venous system PVS , which drains the blood from the gastrointestinal tract, gallbladder, pancreas, and spleen to the liver.

Teaching points Portal venous system drains blood from the gastrointestinal tract apart from the lower section of rectum , spleen, pancreas, and gallbladder to the liver. Introduction Portal venous system PVS drains blood from the gastrointestinal tract apart from the lower section of rectum , spleen, pancreas, and gallbladder to the liver.

Open in a separate window. Unusual topography Normal PV lies posterior to the first part of the duodenum, as it derives embryologically from the dorsal anastomosis of vitelline veins.

Congenital portal venous shunts Portal venous shunts are abnormal communications between portal and systemic venous systems portosystemic shunts , or between the PVS and the hepatic artery arterioportal shunts. Cancer Causes and Prevention. Risk Factors. Cancer Prevention Overview. Cancer Screening Overview. Screening Tests. Diagnosis and Staging. Questions to Ask about Your Diagnosis. Types of Cancer Treatment. Side Effects of Cancer Treatment. Clinical Trials Information. A to Z List of Cancer Drugs.

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Clinical Trials during Coronavirus. Adolescents and Young Adults with Cancer. Emotional Support for Young People with Cancer. Cancers by Body Location. Late Effects of Childhood Cancer Treatment. Common hepatic duct. Intermediate branch of hepatic artery. Hepatic artery proper. Read this next. Medically reviewed by Alana Biggers, M. Common hepatic duct Medically reviewed by the Healthline Medical Network.

Intermediate branch of hepatic artery Medically reviewed by the Healthline Medical Network. Hepatic artery proper Medically reviewed by the Healthline Medical Network. Hepatic veins Medically reviewed by the Healthline Medical Network. What is the Vagus Nerve? Medically reviewed by Seunggu Han, M. Hepatic encephalopathy is a complication of cirrhosis characterized by problems with cognitive and motor function. In severe cases, patients may experience alterations in their level of consciousness.

Toxic substances—normally processed by the liver—are allowed to circulate throughout the body, affecting brain function. Several different strategies exist to treat portal hypertension. Removing the cause of cirrhosis such as alcohol or viruses can significantly improve patient symptoms. Also, medications may reduce blood flow into portosystemic collaterals, or reduce resistance to blood flow within the liver. Patients with refractory ascites or GI bleeding may benefit from the surgical placement of shunts between the portal and systemic circulation.

For example, a transjugular intrahepatic portosystemic shunt TIPS is a shunt placed inside the liver that carries blood directly from the portal veins into the systemic circulation.

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Cheluvashetty, SB. Unusual branching pattern of the portal vein: its importance. Congenital absence of the portal vein. Case report and a review of literature. Iqbal, S. Surgical implications of portal vein variations and liver segmentations: a recent update. Cleveland Clinic. Portal hypertension. Updated November 16, Trebicka J, Strassburg CP. Etiology and complications of portal vein thrombosis.

Biecker, E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management. Moore, CM. Cirrhotic ascites review: pathophysiology, diagnosis, and management.