Type:
Educational Exhibit
Keywords:
Abdomen, Anatomy, Emergency, CT, Ultrasound, Complications, Localisation, Fistula, Infection, Inflammation
Authors:
M. Fdez. del Castillo Ascanio, D. Eiroa, N. Núñez Vila, C. A. Marichal Hernández, Y. El Khatib Ghzal, S. Benítez Rivero, V. Pantoja Ortiz, S. Garrido Carrasco; Santa Cruz de Tenerife/ES
DOI:
10.26044/ecr2019/C-0374
Background
Subcapsular hepatic collections may arise from a variety of sources.
An understanding of the anatomy of the fascial structures is important when interpreting imaging studies,
such as computed tomography (CT),
and correctly diagnosing such fluid collections.
The liver capsule is composed of two adherent layers (figure 1): a thick fibrous inner layer,
Glisson’s capsule,
which covers the entire surface of the liver,
and an outer serous layer that is derived from the visceral peritoneum.
The subcapsular space is a potential space that is deep to the Glisson capsule and superficial to the liver parenchyma (1).
The postero-cranial aspect of the liver is not completely covered by peritoneum,
resulting in the so-called "bare area" (2),
and the bed of the gallbladder and porta hepatis are other locations that are not covered by peritoneum (3).
At the same time,
the liver is anatomically fixed by different ligaments consisting of peritoneal reflections:
- Falciform ligament (separate the right from the left lobe) which extends from the umbilical region to fix it to the anterior abdominal wall,
and towards the antero-superior face of the liver to fix it to the diaphragm and create the right and left subfrenic spaces.
The falciform ligament is continued with the coronary and triangular ligaments.
- Hepato-duodenal ligament: connects the duodenum to the liver supporting the portal vein and hepatic artery as well as the bile duct.
It´s a route to the intrahepatic collections (figure 2).
- Gastro-hepatic ligament: connects the minor curvature of the stomach to the liver and it is a route of expansion of pancreatic collections into the subcapsular hepatic space (figure 2).
- Round ligament: fixes the liver to the anterior abdominal wall and results from the obliteration of the umbilical vein (4).
Blood,
pus,
pancreatic fluids and bile are some of the possibilities that we can find at this location (1).
Because of the layers of the perihepatic space,
the subcapsular collections should have lentiform shape (figure 3) with compression of the adjacent parenchyma.
Subcapsular fluid collections were defined as fluid deep in the liver capsule and superficial to the liver parenchyma without rupture into the peritoneum (5).
We have to look for small details that will guide us to the origin of these collections.