Vascular architecture in anomalous right-sided ligamentum teres: three-dimensional analyses in 35 patients

Abstract

Although the right-sided components of the livers are well developed as a result of the right-dominant distribution of the feeding vessels in livers with RSLT, the basic segmental structure defined by the four sectors and the three hepatic veins are as well preserved as those in the typical liver anatomy.

Biliary architecture of livers exhibiting right-sided ligamentum teres: an indication for preoperative cholangiography prior to major hepatectomy

“…previously reported that the symmetrical configuration of the portal/hepatic venous systems and the segmental anatomy seen in the early stages of hepatic development are well preserved in adult livers with RSLT, as they are in normal livers 1, 5. (Fig.…”

“…RSLT was suspected when one of the following findings was encountered during the initial CT screening: a strong deviation of the umbilical portion towards the right, a lack of liver parenchyma between the gallbladder and the umbilical portion, or a deeply fissured groove for the ligamentum venosum near the level of the portal bifurcation 1 . Then, the three-dimensional (3D) portal-hepatic venous relationship was examined using CT, 3D-CT, and magnetic resonance imaging (MRI) to obtain a definitive diagnosis of RSLT, as described previously 1, 11. First, the right lateral portal pedicle (Sg.…”

“…Right-sided ligamentum teres (RSLT) is a relatively rare congenital anomaly in which the fetal umbilical vein is connected to the right paramedian trunk of the portal vein; however, it can have clinically important implications for hepatobiliary surgery 1, 2. RSLT is sometimes encountered during cholecystectomy or hepatobiliary surgery and has a reported prevalence of 0.2%–1.2% in the adult population 3, 4.…”

“…RSLT is sometimes encountered during cholecystectomy or hepatobiliary surgery and has a reported prevalence of 0.2%–1.2% in the adult population 3, 4. As this anomaly results in a right-sided dominant distribution of the portal veins, the segmental anatomy of adult livers with RSLT exhibits “extreme right-side dominance”, even though the external appearance of the liver is similar to that of a normal liver, except for the reversed positions and a small gap between the gallbladder and the ligamentum teres 1 . (Fig.…”

“…(Fig. 1b) Thus, in RSLT livers the basic vascular architecture of the portal vein, hepatic vein, and hepatic artery are established according to the developmental anatomy of the liver 1 . However, the anatomical characteristics of the biliary system in RSLT livers are not yet fully understood because of the difficulty of evaluating the confluence patterns of the biliary tree on computed tomography (CT) images.…”