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The middle hepatic vein drains the central portion of the liver, draining segments IV, V, and VIII. The middle hepatic vein most often joins the left hepatic vein to form a short common trunk to drain jointly into the inferior vena cava; the middle hepatic vein drains into the inferior vena cava as a separate vessel in less than 10% of individuals.
Mumoli's sign (also known as a "Playboy Rabbit" sign) is a radiologic sign seen in the normal liver. It appears as a rabbit-shaped image caused by the confluence of the middle and right hepatic veins as they merge with the inferior vena cava. It can be seen on ultrasound images of the liver with a transverse subcostal view during deep inspiration.
The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins , usually at the level of the fifth lumbar vertebra .
It may receive its supply from both the right and the left branches of portal vein. It contains one or more hepatic veins which drain directly into the inferior vena cava (IVC). [1] The caudate lobe is a separate structure which receives blood flow from both the right- and left-sided vascular branches. [5] [6]
The hepatic vein subsequently drains into the inferior vena cava. The hepatic artery provides 30 to 40% of the oxygen to the liver, while only accounting for 25% of the total liver blood flow. The rest comes from the partially deoxygenated blood from the portal vein. The liver consumes about 20% of the total body oxygen when at rest.
The division divides the liver into two planes. It extends from the middle hepatic vein (or the inferior vena cava) to the middle of the gallbladder. [1] [2]Using Couinaud's classification system, segments two, three, and both parts of four are on the left side of the division, while segments five, six, seven, and eight are on the right.
This enables the interventional radiologist to gain access to the patient's hepatic vein by traveling from the superior vena cava into the inferior vena cava and finally the hepatic vein. Once the catheter is in the hepatic vein, a wedge pressure is obtained to calculate the pressure gradient in the liver.
An equivalent clot in the vasculature that exits the liver carrying deoxygenated blood to the right atrium via the inferior vena cava, is known as hepatic vein thrombosis or Budd-Chiari syndrome. [ 2 ]