Ultrasonic study of venous patterns in the right hypochondrium: An anatomical approach to differential diagnosis of obstructive jaundice

Abstract

Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused by portal hypertension, systemic venous enlargement caused by cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.

Normal and Obstructed Main Bile Duct Evaluated by a Modified Ultrasound Technique

“…As the extrahepatic biliary system cannot be separated at ultrasound examination into common hepatic, cystic and common bile ducts, most authors use the term 'common duct' (LEE et coIl. 1977, PARULEKAR) or 'main bile duct' (WEILL 1978) for the entire extrahepatic biliary ductal system, as in the present report.…”

Grey-scale ultrasonic characteristics of carcinoma of the pancreas

“…Attention to detail of the adjacent vasculature usually facilitates demonstration of the head and body of the pancreas (Filly and Carlson, 19766;Weill et al, 1975;Skolnick and Royal, 1976). In the transverse scans, the splenic vein and the superior mesenteric vessels, lying anterior to the aorta and vena cava, delineate the posterior asspect of the head, body and tail of the pancreas.…”

“…The recent ultrasound literature contains numerous reports on the normal appearances of the pancreas (Haber et al, 1976;Weill et al, 1977;Doust and Pierce, 1976;Doust, 1975) the vascular anatomy of the upper abdomen as it relates to the pancreas (Sample, 1977;Filly and Carlson, 1976a, b) and the accuracy of ultrasonic examination in the diagnosis of various pancreatic conditions (Leopold, 1975;Weill et al, 1975). This study was undertaken to determine the grey-scale ultrasonic appearances of carcinoma of the pancreas, the displacement and distortion of the local anatomy, and the relative frequency of these manifestations, in an attempt to define the ultrasonic criteria leading to a diagnosis of carcinoma of the pancreas.…”

Computed body tomography and gray scale ultrasonography: Anatomic correlations and pitfalls in the upper abdomen

“…As a result, proper identification depends on their different anatomic courses [5,6]. As one progresses from a cepahalad to caudal direction, the hepatic artery courses medially in the same anteroposterior plane and joins the splenic and celiac arteries.…”