Learning objectives
To review the normal anatomy of the porta hepatis and discuss the spectrum of pathologies affecting its contents.
To illustrate the role of different imaging modalities in detection and characterization of different porta hepatis pathologies.
To illustrate the role of hybrid imaging indiagnosis and follow up of Lympho-proliferative disorders implicating the porta hepatis
Background
Porta hepatis,
a Latin word for liver gate,
contains the main portal vein,
common hepatic artery,
common hepatic duct,
nerves,
lymphatics and connective tissues.
Pathologies arising from these structures can be classified as vascular versus non-vascular or benign versus malignant entities.
Additionally,
lesions from adjacent structures such as duodenum and pancreatic head can extend into the porta hepatis.
Advances in imaging modalities enabled accurate detection with excellent spatial resolution,
thus improving patient management and outcome.
Anatomy of the Porta Hepatis
Theportaortransverse fissure(porta hepatis) is a...
Findings and procedure details
Lesions Of The Porta Hepatis
Imaging features of common lesions of the porta hepatis
Imaging modalities for evaluation
Ultrasound
Ultrasonography is the initial imaging modality of all liver and biliary pathology.
The most important advantages of US is being widely available,
inexpensive and lacks ionizing radiation.
Other advantages of sonography are the real-time nature of the examination,
and utility for guiding percutaneous biopsies and drainages.
Colour Doppler
Ultrasound coloured Doppler examionations allow excellent visualization of the hepatic artery (HA) and portal vein (PV).
It is...
Conclusion
Ultrasound is the initial imaging modality for assessment of porta hepatis lymph nodes,
vascular and biliary pathology.
Porta hepatis lymphadenopathy,
is best diagnosed morphologically by CECT and functionally by PET/CT.
Contrast-enhanced CT is considered to be the ‘gold standard’ in the diagnostics of the vascular lesions and PH tumours.
MRI & MRCP is the main stay in diagnosing biliary pathology.
Image-guided interventions including angiography,
ERCP and endoscopic ultrasoundare important in diagnosis and non-surgical management of porta hepatispathologies.
References
Weinstein JB,
Heiken JP,
Lee JK,
DiSantis DJ,
Balfe DM,
Weyman PJ,
et al.
High resolution CT of the porta hepatis and hepatoduodenal ligament.
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