The hepatic venous system. Its pathologic roentgen anatomy.

Abstract

Pathological changes of parenchymal organs such as the liver may be reflected in pathologic-anatomical changes of the three vascular systems of the liver: the portal venous, the hepatic arterial, and the hepatic venous. The pathologic-anatomic changes of these three systems have been described (4–6). The purpose of this study is to describe the pathologic-roentgen-anatomic changes of the hepatic venous system associated with the most common pathologic conditions of the liver. Our material included 25 cases of liver cirrhosis, 15 of liver metastases, 3 of cardiac cirrhosis, 2 of fatty metamorphosis, and 1 of hepatic venous thrombosis. At postmortem examination 1,000 cc of barium suspension was injected into one of the spermatic or ovarian veins, and two anteroposterior stereo films of the abdomen were obtained. Changes of the Hepatic Veins in Liver Cirrhosis The cirrhotic process of the liver starts at the periphery of the hepatic lobules and interferes with their function during its progress. In constrictive fibrosis of the interlobular septa the involvement of the sublobular and interlobular hepatic veins and of the lobar hepatic veins is similar to that of the portal venous branches, the biliary radicles, and the hepatic arterial branches. The obliterative fibrosing process interferes indirectly rather than directly with the circulation of the central veins of the hepatic lobules. Correspondingly, the patterns of the hepatic veins in liver cirrhosis are apparently not true patterns, but rather represent transitional phases of a process of obliteration of the hepatic venous system. These phases can be found with any of the normal anatomic patterns described earlier (Radiology 90: 1119–1123, June 1968). The original patterns might be so distorted that they are no longer recognized. The following phases of the cirrhotic obliterative process of the hepatic venous system were classified as follows: (a) “Pseudonormal phase” (Fig. 1). (b) “Funnel phase” (Fig. 2). (c) The “leafless tree phase” (Fig. 3). (d) The “tree-stump phase” (Figs. 4 and 5). (e) The “recanalization” phase (Fig. 6). The objection that the described pathological phases could be explained by simple nonfilling or by a postmortem artefact can be answered by the fact that in all other cases except cirrhosis, complete filling of the hepatic venous system was obtained. Moreover, the characteristic appearance of the pathological phase was repeatedly found and only in cirrhosis and metastases. Pathologic Phases of Hepatic Venous System and Its Relation to Liver Pathology The described pathologic-roentgen-anatomic phases of the hepatic venous system were compared with the liver chemistry. There was no correlation with the Hanger and thymol turbidity tests in any of the phases, or with the alkaline phosphatase values. The reversal of the albumin-globulin ratio appeared to be slightly more pronounced in the leafless-tree and tree-stump phases than in the others.