Diaphragmatic sulci and portal fissures

Abstract

Diaphragmatic sulci in the superior surface of the liver were found in 40% of cases at autopsy. All sulci were located in the right lobe and in 47% they were multiple. In order to evaluate possible predisposing factors for these accessory sulci, their topography and characteristics were observed in unfixed livers; moreover, intravenous injections of radio-opaque resins were performed in the portal and hepatic veins (HVs). After formalin fixation, the livers underwent CT and MR scans and a three-dimensional (3D) elaboration of the images was performed. Radiological examination revealed a correspondence between the topography of the sulci and the course of the right and middle HVs and their main tributaries in 67%. The corrosion casts showed the location of the sulci at the level of the boundaries between the ramifications of the terminal branches of the portal triad, where the HVs are located, in 73%. These findings suggest that, rather than the action of 'special' or hypertrophied muscle bundles, the pressure exerted by the diaphragm as a whole may be responsible for the production of sulci at the level of weak zones, represented by the portal fissures, where the watershed superficial hepatic parenchyma, owing to the absence of all but the smallest vascular branches, exhibits a lower resistance to external pressure.

Cadaveric Study of Accessory Grooves on Liver in West Bengal Population

“…They may also increase the complexity in the liver transplantation by hepato-billiary surgeons [10]. The prevalence of HSG in this Afro-Caribbean population is comparable with that in published series, ranging from 5% in Malaysia [6], 6% in India [11], 25% in New York, USA 2 to 40% in Italy [4]. The majority of HSGs occurred at the antero-superior surface near the midline.…”

“…Accessory grooves are prominent vertical depression that appear on the hepatic surfaces. There is no unanimous nomenclature since various researchers used different names including accessory fissures [2], hepatic fissures [3], diaphragmatic sulci [4], hepatic furrows [5] Liver is the largest vital organ, occupying right hypochondrium and epigastric region, extending into left hypochondrium as far as left lateral line of the abdominal cavity. It is convex in the front, to the right, above, and behind; and is somewhat concave inferiorly, where it is moulded to the shapes of the adjacent viscera [1].…”

“…Studies on the variations in ductal and vascular anatomy of the liver are common, But literature pertaining to presence of grooves on hepatic surface is very scarce [2][3][4][5][6]. Accessory grooves are prominent vertical depression that appear on the hepatic surfaces.…”

Anatomic variations of the liver surface detected by the multidedector computed tomography

“…As a result, the peritoneal implant-like appearance on the lateral aspects of the liver dome was interpreted as age-related diaphragmatic muscle change. Prominent muscular slips of the diaphragm may be seen as soft-tissue nodules in contiguity with the diaphragm on sectional imaging modalities [1,3]. Prominent diaphragmatic slips may mimic perihepatic metastatic peritoneal implants, resulting in unnecessary follow-up investigations and patient anxiety.…”

“…Similar to the soft tissues in other parts of the body, abdominal muscles can show degenerative changes with ageing [1][2][3][4].…”