Left Hepatic Lobe Research Articles

Resection for a Recurrent Mucus-Producing Cholangiocarcinoma After Surgery: a Case Report

Introduction Intraductal papillary neoplasm of the bile duct (IPNB) is a variant of bile duct carcinoma characterized by intraductal growth. There are few case reports and papers discussing treatment policy and prognosis for cases of postoperative relapse. Case Presentation The case subject was a female in her 40s. Due to IPNB with the primary tumor in hepatic left lobe, the patient underwent hepatic left lobe, caudate lobe, and bile duct resection, and biliary tract reconstruction at another institution. Four years later, near the cholangiojejunostomy, a localized recurrence was indicated. Though systemic metastasis was examined with CT, FDG-PET, distant metastasis was not confirmed. As it was believed that resection of the recurrent focal could lead to a long-term survival, the recurrent focal was resected. The resected specimen was a cystic mass with a film, and in a pathologic examination, lymph node tissue was not confirmed in the specimen, while intracystic papilloma of attached liver tissue without continuity was confirmed. The patient has not seen a relapse for 5 years and 5 months after the second surgery. Conclusion In a case of localized recurrence after the IPNB surgery, resection should be actively considered.

A Pig Model of Hemivascular Liver Occlusion for The Study of Ischemia-Reperfusion Injury: Use of an Infrared System for Detecting Ischemic Areas

<p class=MsoFooterCxSpFirst style=text-align:justify;tab-stops:.5in; mso-mirror-indents:yes> Abstract <span lang=EN-GB style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-GB>Aim: <span lang=EN-GB style=font-size:10.0pt;color:black; mso-themecolor:text1;mso-ansi-language:EN-GB>Different animals are used as experimental models for the hepatic Ischemia- Reperfusion (IR) injury investigations and for each one of these animal models, many different surgical approaches have been performed. The aim of our study was to establish a new surgical pig model in which a hemi-liver is used to study the pathophysiology of hepatic IR injury. Contro-lateral hemi-liver is used as an internal control in the same animal. <span style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-US>Methods: <span style=font-size:10.0pt;color:black;mso-themecolor: text1;mso-ansi-language:EN-US> Liver ischemia was performed in six pigs by clamping the hepatic artery and vein and the portal vein to isolate the left hepatic lobe. Four hours of warm ischemia were followed by 4-hourrs of reperfusion. Biochemical and hematological analyses were performed throughout the experiments. Needle biopsies were obtained prior to ischemia and then hourly during the reperfusion for evaluation of tissue damage. <span lang=EN-GB style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-GB>To assess local temperature gradients on the liver surface a focal plane array detector camera was used. <span lang=EN-GB style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-GB>Results: <span lang=EN-GB style=font-size:10.0pt;color:black; mso-themecolor:text1;mso-ansi-language:EN-GB>Four hours ischemia induced mild signs of hepatic damage on the left ischemic lobe while more dramatic changes were evidenced after 2-hours reperfusion. Absence of tissue damage was detected on the right lobe. The liver functional test reached their maximum value at 2-4 hours after reperfusion. <span lang=EN-GB style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-GB>Conclusion: <span lang=EN-GB style=font-size:10.0pt; color:black;mso-themecolor:text1;mso-ansi-language:EN-GB>Our model is easy to perform, feasible and reproducible. This surgical model minimizes biases dependent on the individual response of different animals under the same conditions. In this IR model the new technology of an infrared thermocamera was used to control temperature changes and provide clinically important real-time information during surgery. <p class=MsoFooterCxSpMiddle style=text-align:justify;tab-stops:.5in; mso-mirror-indents:yes> <span style=font-size:11.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-US>Abbreviations: <span style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-US> <span style=font-size:10.0pt;color:black;mso-themecolor: text1;mso-ansi-language:EN-US>IR: Ischemia/Reperfusion; IV: Intravenous; <span lang=EN-GB style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-GB>ALP: Alkaline Phosphatase; ALT: Serum Alanine Aminotrasferase; AST: Aspartate Aminotransferase; LDH: Lactate Dehydrogenase; <span style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-US>ROI: Region of Interest <p class=MsoFooterCxSpLast style=text-align:justify;tab-stops:.5in;mso-mirror-indents: yes> <span style=font-size:11.0pt; color:black;mso-themecolor:text1;mso-ansi-language:EN-US>Keywords: <span style=font-size:10.0pt;color:black; mso-themecolor:text1;mso-ansi-language:EN-US> <span style=font-size:10.0pt;color:black;mso-themecolor:text1;mso-ansi-language: EN-US;mso-bidi-font-weight:bold>Animal model; Infrared imaging; Liver ischemia reperfusion injury, Liver transplantation <span style=font-size:10.0pt;color:black;mso-themecolor:text1; mso-ansi-language:EN-US>

DISTRIBUTION OF THE HEPATIC BLOOD VESSELS OF THE GROUND SQUIRREL (SPERMOPHILUS CITELLUS)

The aim of this paper was to study distribution of the hepatic artery and portal vein of theportal system of the liver in ground squirrels (Spermophilus citellus) and compare these data withthose concerning the rats, rabbits, guinea pigs and nutrias. The liver of the ground squirrel receivesthe oxygen and nutrients through blood from two large blood vessels: portal vein and hepatic artery(a. hepatica propria). The portal vein is formed by the confluence of three main venous bloodvessels: v. gastropancreaticoduodenalis, v. gastrolienalis and v. mesenterica cranialis. It collectsvenous blood from the stomach, pancreas, spleen and all of intestines except the rectum. The portalvein enters the porta hepatis on the liver together with the hepatic artery. Five venous branches ofdifferent size separate from the portal vein and ramify into the respective liver lobes.Blood leaves the liver through the hepatic veins that start with the central veins. Three large hepaticveins and two venous trunks drain lobes of the liver and enter the caudal vena cava as it passesthrough the liver.A. hepatica propria supplies the liver and gallbladder with oxygenated blood. It raises from thehepatic artery (a. hepatica) wich is the third branch of the celiac artery. A. hepatica propria in theportal fissure is divided into two branches, of which the left branch brings arterial blood to the lefthepatic lobe, and the right branch brings it into other liver lobes.

Percutaneous treatment of IVC obstruction due to post-resection hepatic torsion associated with IVC thrombosis

BackgroundMigration of the left hepatic lobe into the potential space following right lobe resection can result in torsion and hepatic venous outflow obstruction with compromised venous return from the IVC. If untreated, significant morbidity and mortality can develop.Case presentationWe report a case of a 29-year-old female with Lynch syndrome who underwent right lobe resection for a metastatic hepatic tumor. There was subsequent migration of the liver remnant, torsion of the IVC, and impaired hepatic outflow, successfully treated with thrombectomy and stenting.ConclusionFollowing right hepatectomy, hepatic venous outflow obstruction should be consdered in the setting of hepatorenal failure and hemodynamic instability. Endovascular stenting is a viable treatment option.

SAT-611 Abdominal Goiter

A 79 year old woman with hyperlipidemia, hypertension, congestive heart failure was referred for evaluation of ectopic thyroid tissue found on a liver biopsy. The patient originally presented with abdominal pain and was noted to have a liver mass measuring 5.7 x 3.2 x 5 cm on computed tomography (CT) that appeared contiguous with the medial segment of the left hepatic lobe. A subsequent ultrasound (US) showed the same 3.1 x 4.7 x 4.7 cm ovoid mass with a central focus of increased echogenicity and a well-circumscribed margin; a fine needle aspiration (FNA) of the hepatic lesion showed thyroid follicular cells and abundant colloid. Magnetic resonance imaging of the abdomen was done 6 months later, which showed a soft tissue abnormality in the porta hepatis extending centrally into the liver of decreased T2 signal intensity relative to the liver and containing iron deposition. The size of the lesion by MRI was unchanged in comparison with the CT. Eight years later, she presented to the Emergency Room with suprapubic abdominal pain. On CT, she had a large mass (8.3 x 5.5 x 7.1 cm) in the porta hepatis with mass effect upon the gallbladder and pancreas without biliary dilatation or evidence of frank invasion. An FNA was repeated, again showing benign appearing thyroid tissue (bland follicular cells without features of papillary thyroid cancer and abundant colloid). Immunohistochemical staining for TTF-1 was positive, supporting thyroid origin. Thyroid function tests were normal ( TSH-0.85 uIU/mL; free T4 direct- 1.1 ng/dL; and total T3 - 125 ng/dL) There are only three prior case reports detailing ectopic thyroid tissue in the porta hepatis (1). Benign ectopic thyroid tissue in the liver is generally explained as a metaplastic phenomenon, as the thyroid shares a common embryologic origin with the liver and proximal segment of the gastrointestinal tract (2). Workup typically includes CT or US imaging, followed by I-123 imaging to determine the presence of functional thyroid tissue, followed by a biopsy. The prevalence of all ectopic thyroid tissue is 1 per 100,000-300,000 persons, with less than 1% being malignant. The majority (85%) of malignant ectopic thyroid tissue is papillary thyroid cancer. Excision of ectopic thyroid mass in the liver has generally been favored, due to their minor malignant potential. The patient has been referred to Surgical Oncology/Endocrine Surgery for possible resection.

Rare Complication of Peptic Ulcer Disease in a Hemopheliac

A49 year-old Caucasian man presented to the Emergency Department for hematemesis and syncope. He had a history of hemophilia A. He was lethargic, hypotensive, and tachycardic upon presentation. He was adequately stabilized with fluids, blood products, and recombinant factor VIII. Computed tomography with contrast of the abdomen and pelvis showed an 8 cm × 6 cm × 9 cm hematoma vs abscess interposed between the left hepatic lobe of a cirrhotic liver and the gastric antrum (Figure A, white arrows). An esophagogastroduodenoscopy showed a 3.5-cm fibrous clot eroding through the gastric mucosa (Figure B), with extrinsic compression along the wall of the anterior portion of the gastric antrum (Figure C).

03:36 PM Abstract No. 310 Ultrasound elastography–guided liver biopsy: a value added technique to improve histopathological yield of liver fibrosis

Liver fibrosis (LF) is essential in the evaluation of the severity of chronic liver disease as well as in its therapy. Liver biopsy, which can only assess a very limited part of the whole liver while fibrosis is a heterogeneously distributed lesion, is limited by sampling variability and therefore inaccurate histopathological yield. The objective of the study was to describe and evaluate a novel technique to enhance the histopathological yield by using ultrasound elastography simultaneously during liver biopsy. A total of 31 patients with chronic liver disease underwent ultrasound elastography–guided liver biopsy using an ultrasound unit (Siemens Acuson S3000) to determine quantitatively the liver stiffness (LS) and tissue elasticity with the Virtual Touch Tissue Quantification (VTTQ) and Imaging Quantification (VTIQ). The highest weighted LS liver tissue was then biopsied via intercostal and subcostal approaches for the right hepatic lobe and via an epigastric approach for the left hepatic lobe. The combined lengths of specimen fragments and the total number of complete portal tracts were measured by pathology. LS measurements were statistically correlated with different histopathological stages of fibrosis as well as the activity of necroinflammatory scoring systems composed of progressive stages: F0 (normal), F1 (portal fibrosis without septa), F2 (portal fibrosis few fibrotic septa), F3 (portal fibrosis with numerous septa) and F4 (cirrhosis), with p-value of 0.05 as considered significant. Valid LS and shearwave velocities measurements were obtained from all 31 patients except two patients (measurements had failed due to congestive heart failure and ascites). A gradual increase in mean LS measurements and shearwave velocities was noted from fibrosis of stages F1 to F4 with significant correlation between ultrasound elastography measurements and histopathological fibrosis stage (r = 0.95, p < 0.001) when compared to liver biopsy done without elastography. Ultrasound elastography–guided liver biopsy can improve histopathological yield in detecting liver fibrosis in patients with chronic liver disease.

Shrinkage of hepatocellular carcinoma after radiofrequency ablation following transcatheter arterial chemoembolization: Analysis of contributing factors.

ObjectiveThis study was conducted to investigate tumor shrinkage and influencing factors in patients with hepatocellular carcinoma (HCC) from radiofrequency (RF) ablation following transcatheter arterial chemoembolization (TACE).MethodsA total of 222 patients underwent combined sequential treatment of TACE and RF ablation for HCC at our institution between 2008 and 2014. Of those, 86 patients (men, 68; women, 18) who achieved compact iodized oil tagging and complete ablation were included for this retrospective study. We measured three-dimensional tumor diameters and calculated tumor volumes on pre-treatment CT/MRI and follow-up CT scans performed post-TACE, post-ablation, and 1 month post-treatment, respectively. To compare periodically generated tumor diameters and volumes, repeated measures analysis of variance (ANOVA) was applied. Multiple linear regression analysis was performed to identify factors impacting tumor shrinkage after RF ablation.ResultsDiameters and volumes of HCCs declined significantly in the immediate aftermath of RF ablation (i.e., between post-TACE and post-ablation CT scans) (p < 0.001, for both). Mean reduction rates in tumor diameter and volume immediately after RF ablation were 18.2 ± 9.1% and 44.4 ± 14.6%, respectively. Of note, tumors of left hepatic lobe and in subphrenic or perivascular locations showed lower rates of post-ablative volume reduction than those in counterpart locations (p = 0.002, 0.046, 0.024, respectively). Tumor size and liver function did not influence tumor shrinkage after RF ablation.ConclusionIn patients with HCC, significant tumor shrinkage occurs immediately after RF ablation. The degree of shrinkage in response to ablative treatment seems to vary by tumor location.

Progressive atrophy in a deformed liver as a contributor to sigmoid volvulus

The effect of a prior defect on secondary liver atrophy is unknown. We describe a case of sigmoid volvulus that was facilitated by progressive atrophy in a deformed liver. A 75-year-old man with abdominal pain and fullness was referred to our hospital. Computed tomography (CT) revealed reduced left hepatic lobe volume and a whirl sign, characteristic of sigmoid volvulus. The sigmoid volvulus was successfully detorted with endoscopy. Retrospective evaluation of liver morphology on CT and magnetic resonance imaging showed that the portal vein at the liver hilum was denuded due to a parenchymal defect of the medial segment, with compression by the crossing artery. As pulse Doppler ultrasonography demonstrated reduced portal blood flow in the region where liver atrophy developed, compression of the denuded portal vein presumably facilitated secondary atrophy and contributed to sigmoid volvulus. The present case shows that a deformed liver itself can be a cause of secondary atrophy. Therefore, continued monitoring of liver morphology and evaluation of portal blood flow to predict liver atrophy may be required, when an individual with a partial liver defect is encountered.

Endoscopic trans-esophageal submucosal tunneling surgery: A new therapeutic approach for diseases located around the aorta ventralis.

AIMTo assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery (EESTS) technique for diseases located around the aorta ventralis.METHODSNine pigs were assigned to EESTs. The procedures were as follows: First, a long esophageal submucosal tunnel was established. Second, full-thickness myotomy was created. Third, an endoscope was entered into the abdominal cavity through a muscle incision and the endoscope was around the aorta ventralis. Eventually, celiac trunk ganglion neurolysis, partial hepatectomy and splenectomy, partial tissue resection in the area of the posterior peritoneum, and endoscopic submucosal dissection (ESD) combined with lymph node dissection were performed. The animals were given antibiotics for 5 d and necropsied 7 d after surgery.RESULTSIn all surgeries, one pig died from intraperitoneal hemorrhage after doing partial splenectomy, while the other pigs were alive after successfully operating other surgeries. For surgery of celiac trunk ganglion damage, at necropsy, there was no exudation in the abdominal cavity. Regarding surgery of partial hepatectomy, the wound with part healing was observed in the left hepatic lobe, and no bleeding or obvious exudation was seen. In surgery of partial splenectomy, massive hemorrhage was observed on the splenic wound surface, and the metal clips could not stop bleeding. After surgery of retroperitoneal tissue resection, mild tissue adhesion was observed in the abdominal cavity of one animal, and another one suffered from severe infection. For surgery of ESD and lymph node dissection, a moderate tissue adhesion was observed.CONCLUSIONEESTS is a feasible and safe technique for diseases located around the aorta ventralis.

Studying the left hepatic lobe(lt lobe) sonographic morphometry in bilharzial periportal fibrosis(ppf). Is the it lobe enlargement exaggerated?

Introduction PPF is a parasitic disease jeopardizing life of mostly young male farmers at agricultural schemes, 70% of whom present with variceal bleeding. Sonography is a corner stone in the diagnosis & characterization of the disease. A paradoxically enlarged protuberant Lt Lobe against a shrunken right(Rt) lobe defines the clinic-morphological character of the disease. The concept is explained on the basis of the anatomical lay out of the PV & its 2 branches. The Lt Lobe is demonstrated to attain antigravity flow compared to the Rt. Thereby the Rt lobe is postulated to receive higher load of Bilharzial eggs due to the lower resistance to portal flow. This results in enhanced PPF changes of Rt lobe ending in reduced portal supply to the Rt lobe compared to the Lt lobe, manifesting as paradoxical volume of the 2 lobes. A different concept is being addressed in this study based on the lack of a conclusive morphometric evidence in the literature, together with the sonographic observation of the increase in the anterio posterior diameter(AP) of Ltlobe thereby, pushing the lobe forward compared to a reduction at the cranio caudal(CC) diameter, the widening of the inferior angle of the LtLobe & the stereological plane of the PPF bands pulling on the LtLobe Aims & Methods To assess Lt lobe morphometry, debating & finding cause of the theory of an enlarged LtLobe in PPF. 100 consecutive cases with proven PPF were sonographically studied, in addition to 50 normal controls in the period between March and September 2015 Results Lt Lobe AP diameter was significantly increased, supported also by an enlarged caudate lobe which adds more length to the AP diameter, while both CC diameter of the lobe & mid cranio caudal diameters were significantly reduced. The plane of the portal fibrotic bands were demonstrated to assist in squeezing the lobe to a more CC plane there by adding more length to the AP of the Lt Lobe Conclusion A clinically palpable Lt hepatic lobe is in part explained by remodeling of the lobe imposed by a directionally guided pulling force on the lobe by the fibrotic bands of the portal vein wall & the enlargement of the caudate lobe and is responsible in part for the apparent increase of the Lt lobe

A vascular variant allows to resect "en bloc" cholangiocarcinoma Bismuth IV

Background: Curative hepatectomy with bile duct resection is the treatment for perihilar cholangiocarcinoma. When vessel involvement in imaging preoperative studies is found, the use of more aggressive aproach with bloc resection is the recommendation. Methods: A video of the surgical approach used in a case of Bismuth type IV Klatskin tumor resected with extended left hepatectomy. Results: A 67-year-old man who presented with epigastric pain and abnormal liver function was referred to our clinic for further examination. Serial examination resulted in diagnosis of Bismuth IV hilar cholangiocarcinoma, atrophying mainly the left hepatic lobe, and infiltrating right and left hepatic artery branches. Fortunately, the patient presented a SVI-VII artery arising from gastroduodenal artery no invaded, anatomical variant that allows tumor resection, keeping the arterial supply of the liver. The variant anatomical of the vessel was identified preoperatively. He underwent left hepatectomy with the main right hepatic artery, caudate lobectomy and extrahepatic bile duct resection without any complications. Pathological study of specimen showed a 4.9x1.2cms cholangiocarcinoma with free margins. No recurrence 1 year late. Conclusion: Aggressive approach with "en bloc" and extended liver resections in the treatment of Bismuth IV hilar cholangiocarcinoma could be feasible. It’s important a meticulous preoperative evaluation with images in this cases, because we can identify anatomical variations make surgery possible.

Laparoscopic left hepatectomy for mucinous cystic neoplasm of the liver

Among liver cystic lesions, mucinous cystic neoplasm of the liver (MCN-L) constitutes a challenging issue in terms of management: preoperative diagnosis is often unachievable and this may mislead to inappropriate treatment [1–3]. We present the case of an otherwise healthy 29-year-old female who underwent laparotomic cyst unroofing in segment 4 and cholecystectomy in another institution. Post-operative course was complicated by biliary leakage that was endoscopically treated. Short term follow-up showed early recurrence with a volumetric enlargement of the cyst occupying most of the left hepatic lobe and new satellite cyst in Sg5. The doubt of MCN-L arose, and the patient was scheduled for laparoscopic removal at our Centre, despite the previous laparotomic procedure. An optic port was placed into right upper abdominal quadrant and 3 further ports were placed. A long and difficult adhesiolysis was performed and Pringle’s manoeuver was settled. Intraoperative US confirmed the anatomic limits of the cysts in Sg5 and in the left hepatic lobe. The cyst on Sg5 was resected first and frozen section was suspicious for MCN-L. In order to prevent recurrence, left laparoscopic hepatectomy was performed. The specimen was extracted through the previous midline laparotomy. Post-operative course was uneventful and the patient was discharged on POD 5. Pathology and immunochemistry confirmed the diagnosis of MCN-L. Hepatic cystic lesions may be insidious and preoperative biopsy is not always possible due to lack of solid tissue. In unclear settings, an intraoperative frozen section is mandatory to guide intraoperative decisions. In the suspicion of malignancy, resection with oncologic criteria must be chosen as the most appropriate treatment, as well as the retrieving of MCN-L requires hepatic resection to avoid early recurrence [4, 5]. Despite of previous laparotomy, we consider a laparoscopic approach could be attempted in selected cases, in institution with particular expertise in laparoscopic liver surgery.

Spontaneous Rupture of Fibrolamellar Variant Hepatocellular Carcinoma

Fibrolamellar hepatocellular carcinoma (FL-HCC) is a unique variant of hepatocellular carcinoma. The majority of cases present with nonspecific symptoms like vague abdominal pain, weight loss and fatigue. Ruptured FL-HCC occurs rarely and mortality in the acute phase is very high. We report a rare case of a ruptured FL-HCC successfully managed with transarterial embolization for hemostasis. A 37-year-old male previously in good health presented with a severe, sharp epigastric pain that started 1 h prior to the presentation. He denied trauma, fever, nausea, vomiting, or diarrhea. Tenderness in the epigastrium was noted, with no palpable masses, guarding or rigidity. His blood pressure and pulse were 159/105 mm Hg and 105 beats/min. Platelets and coagulation parameters were within normal limits; transaminases were elevated. Abdominal computed tomography (CT) scan with contrast revealed an 8 cm lobulated mass with central hypodensity in the left hepatic lobe with perilesional blood and free pelvic fluid, indicating tumor rupture. CT angiography showed tumor neovascularization from a branch of the left hepatic artery which was embolized using transarterial gelfoam. Liver magnetic resonance imaging (MRI) and biopsy were consistent with fibrolamellar variant hepatocellular carcinoma. After 4 days, as the symptoms resolved, and the lab results were stable, patient was discharged and underwent a left hepatectomy 3 weeks later. FL-HCC occurs commonly in the left lobe of a young and non-cirrhotic liver. Typically, cross sectional imaging reveals a lobulated mass with well-defined margins, areas of hypervascularity and a central calcified scar. Histologic appearance is characterized by eosinophilic polygonal shaped cells separated by lamellar fibrosis. Surgical resection is the treatment of choice with better outcome when compared to conventional HCC. Disease recurrence after complete surgical resection is however high in the first 5 years. Tumors > 5 cm in size are at high risk for rupture with high mortality and recurrence rates secondary to significant spillage of tumor. While an emergency hepatectomy is preferred in unstable patients, those that are hemodynamically stable can undergo radiologic transarterial embolization for hemostasis followed by staged hepatectomy.

Torsion of the left medial hepatic lobe as a cause of acute, moderate, continuous colic in a Warmblood horse

Torsion of the left medial hepatic lobe as a cause of acute, moderate, continuous colic in a Warmblood horse

Biliary Rhabdomyosarcoma in an Infant Male With Neurofibromatosis Type 1

Different types of malignancies can be seen in patients with neurofibromatosis type 1 (NF-1). Herein we present a rare combination of NF-1 and biliary rhabdomyosarcoma in a male infant. An 11-month-old boy, who was recently diagnosed with NF-1, presented to the outpatient clinic with a 3-month history of prolonged jaundice, and failure to thrive. Clinical examination showed >20 café au let spots distributed mainly over the abdominal trunk. Hepatomegaly (4 cm below the costal margin) was additionally observed. His father was diagnosed with NF-1. Radiologic imaging studies showed a 6×5×5 cm in diameter cystic mass with multiple septations in the segment 4A of the liver. Surgical excision of the left hepatic lobe followed by hepatojejunostomy was further performed. Histopathology examination showed embryonal type rhabdomyosarcoma originating from the biliary duct. Chemotherapy regimen consisting of cyclophosphamide, actinomycin D, and vincristine, and radiotherapy were then initiated. This treatment led to a significant improvement in the patient's clinical status, and radiologic finding portrayed attainment of complete resolution. He is still in complete remission without any sequelae for 8 years.

Descriptive Anatomy of Hepatic and Portal Veins with Special Reference to Biliary Duct System in Broiler Chickens (Gallus gallus domesticus): A Recent Illustration

ABSTRACT Chickens have a great participation in meat and egg production. The anatomical scientific data of poultry is important to support the recent researches either for illustrations in academic studies or clinically in diagnosis and treatment of some poultry nutritional diseases. The current investigation was performed on twenty broiler chickens of both sexes. The chickens were anaesthetized, slaughtered then the venous system was flushed with a normal saline to anatomically investigate the distribution of hepatic portal veins both intra and extrahepatic, as well as the hepatic venous and biliary duct systems. The fowl had two hepatic portal veins draining the gastrointestinal tract with its associated organs as spleen and pancreas. The left hepatic portal vein was small, restricted to a limited portion of left hepatic lobe and had been constituted by five main venous tributaries draining the proventriculus, gizzard and pylorus, while the right hepatic portal vein was the largest, receiving the proventriculosplenic, gastropancreaticoduodenal and common mesenteric veins then piercing the right hepatic lobe to be distributed in both hepatic segments through right and left divisions. The fowl has two hepatic portal veins differed in size and distribution. A characteristic imaginary trapezoid shape was formed by some tributaries draining the caudoventral part of the gizzard. There are three ileocecal veins; cranial, caudal and the ileocecal tributary of the cranial mesenteric vein. The wall of gall bladder and the common hepatoenteric duct was characterized by the presence of well-defined longitudinal folds or striations.

Improving the Quality of Diffusion-weighted Imaging of the Left Hepatic Lobe Using Weighted Averaging of Signals from Multiple Excitations.

Background:Diffusion-weighted imaging (DWI) is useful for detecting and characterizing liver lesions but is sensitive to organ motion artifact, especially in the left lobe.Purpose:To assess the signal intensity (SI) loss in the left hepatic lobe on DWI depending on motion-proving gradient (MPG) pulse direction (preliminary study) and to evaluate the usefulness of modified signal averaging to reduce the SI loss on DWI (application study).Methods:About 48 (preliminary) and 35 (application) patients were included. In the preliminary study, DWI with four different MPG directions, only a single MPG pulse direction (x-, y-, or z-axis) and all three directions combined (standard DWI), were reconstructed from the original data. In the application study, we examined the usefulness of the weighted averaging number of excitations (wNEX) method, in which a larger weighting factor is applied to the higher signal in pixel-by-pixel NEX signal averaging by comparing four reconstruction methods. We assumed that true signals would be the same in both lobes. The SI and apparent diffusion coefficient (ADC) ratios for the left versus right lobe were calculated by dividing the SI/ADC of the right lobe by that of the left lobe.Results:In the preliminary study, the SI ratio was significantly lower on DWI using only the x-axis but was significantly higher on DWI using only the z-axis (both P < 0.0001) when compared with standard DWI. In the application study, the SI (mean, 1.15–1.17) and ADC (0.90–0.92) ratios on DWI with wNEX were closer to 1.0 than those on standard DWI (SI ratio, 1.32–1.38; ADC ratio 0.80–0.81); the differences were significant (all P < 0.0001).Conclusion:The MPG pulse along the z-axis caused signal loss in the left hepatic lobe. The wNEX reconstruction method effectively reduced signal loss in the left lobe on DWI.

Pediatric ultrasonography of the pancreas: normal and abnormal findings.

The pancreas is easily investigated in children thanks to the relative lack of fat tissue and the large left hepatic lobe with an optimal acoustic window. The use of high frequency, even linear transducers, usually results in detailed images of all pancreatic areas. A wide spectrum of pancreatic pathologic conditions can be identified and monitored at ultrasound although they are relatively uncommon during childhood compared to the adult. In this paper we briefly review the anatomy, technique, and sonographic aspects of normal and pathological pediatric pancreas.

Development of a novel rat model of heterogeneous hepatic injury by injection with colchicine via the splenic vein.

AIMTo develop a novel rat model of heterogeneous hepatic injury.METHODSSeventy male Sprague-Dawley rats were randomly divided into a control group (n = 10) and a colchicine group (n = 60). A 0.25% colchicine solution (0.4 mL/kg) was injected via the splenic vein in the colchicine group to develop a rat model of heterogeneous hepatic injury. An equal volume of normal saline was injected via the splenic vein in the control group. At days 3, 7, and 14 and weeks 4, 8, and 12 after the operation, at least seven rats of the colchicine group were selected randomly for magnetic resonance imaging (MRI) examinations, and then they were euthanized. Ten rats of the control group underwent MRI examinations at the same time points, and then were euthanized at week 12. T2-weighted images (T2WI) and diffusion weighted imaging (DWI) were used to evaluate the heterogeneous hepatic injury. The heterogeneous injury between the left and right hepatic lobes was assessed on liver sections according to the histological scoring criteria, and correlated with the results of MRI study.RESULTSObvious pathological changes occurred in the hepatic parenchyma in the colchicine group. Hepatic injury scores were significantly different between the left and right lobes at each time point (P < 0.05). There was a significant difference in apparent diffusion coefficient (ADC) of DWI and liver-to-muscle ratio (LMR) of T2WI between the left and right lobes of rats in the colchicine group (P < 0.05) at each time point, and similar results were observed between the colchicine and control groups. Besides, there was a significant correlation between hepatic injury scores and ADC values or LMR (r = -0.682, P = 0.000; r = -0.245, P = 0.018).CONCLUSIONInjection with colchicine via the splenic vein can be used to successfully develop a rat model of heterogeneous hepatic injury. DWI and T2WI may help evaluate the heterogeneous injury among liver lobes.