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Relationship between Left Biliary Duct System and Left Portal Vein: Evaluation with Three-dimensional Portocholangiography¹

¹ From the Department of Academic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-0856, Japan (A.C., S.O., Y.Y., Y.I., T.O.); and Department of Surgery, Chiba Prefectural Sawara Hospital, Japan (M.R.). Received June 19, 2002; revision requested August 21; revision received October 10; accepted December 19. Address correspondence to A.C. (e-mail: cho@maple.ocn.ne.jp).

View larger version (25K): [in a new window]   Figure 1a. Diagrams show three variants of left biliary (B) and portal (P) systems. B2 = segment II bile duct, B3 = segment III bile duct, B4 = segment IV bile duct, P2 = segment II portal branch, P3 = segment III portal branch, P4 = segment IV portal branch, UP = umbilical portion. (a) Type 1 variant. Segment II and III ducts unite just above or laterally to umbilical portion; segment IV duct then joins medially to umbilical portion. (b) Type 2 variant. Segment III and IV ducts unite medially to umbilical portion; segment II duct then joins close to the hepatic hilum. (c) Type 3 variant. Three ducts from segments II-IV immediately unite medially to umbilical portion. Left main portal vein bifurcates into the segment II portal branch and the umbilical portion; the umbilical portion then bifurcates into the segment IV and segment III portal branches.

View larger version (25K): [in a new window]   Figure 1b. Diagrams show three variants of left biliary (B) and portal (P) systems. B2 = segment II bile duct, B3 = segment III bile duct, B4 = segment IV bile duct, P2 = segment II portal branch, P3 = segment III portal branch, P4 = segment IV portal branch, UP = umbilical portion. (a) Type 1 variant. Segment II and III ducts unite just above or laterally to umbilical portion; segment IV duct then joins medially to umbilical portion. (b) Type 2 variant. Segment III and IV ducts unite medially to umbilical portion; segment II duct then joins close to the hepatic hilum. (c) Type 3 variant. Three ducts from segments II-IV immediately unite medially to umbilical portion. Left main portal vein bifurcates into the segment II portal branch and the umbilical portion; the umbilical portion then bifurcates into the segment IV and segment III portal branches.

View larger version (26K): [in a new window]   Figure 1c. Diagrams show three variants of left biliary (B) and portal (P) systems. B2 = segment II bile duct, B3 = segment III bile duct, B4 = segment IV bile duct, P2 = segment II portal branch, P3 = segment III portal branch, P4 = segment IV portal branch, UP = umbilical portion. (a) Type 1 variant. Segment II and III ducts unite just above or laterally to umbilical portion; segment IV duct then joins medially to umbilical portion. (b) Type 2 variant. Segment III and IV ducts unite medially to umbilical portion; segment II duct then joins close to the hepatic hilum. (c) Type 3 variant. Three ducts from segments II-IV immediately unite medially to umbilical portion. Left main portal vein bifurcates into the segment II portal branch and the umbilical portion; the umbilical portion then bifurcates into the segment IV and segment III portal branches.

View larger version (153K): [in a new window]   Figure 2a. Bile duct cancer in two patients. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1. (a) Three-dimensional portocholangiogram obtained in a 78-year-old woman shows caudocranial view of portobiliary systems. Segment II and III ducts united (thick arrow) lateral to umbilical portion (thin arrow); then, segment IV duct (arrowhead) joined medially to umbilical portion. (b) Three-dimensional portocholangiogram obtained in a 50-year-old man shows craniocaudal view of portobiliary systems. Segment II and III ducts united (thick arrow) just above umbilical portion (thin arrow); then, segment IV duct (arrowhead) joined medially to umbilical portion.

View larger version (69K): [in a new window]   Figure 2b. Bile duct cancer in two patients. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1. (a) Three-dimensional portocholangiogram obtained in a 78-year-old woman shows caudocranial view of portobiliary systems. Segment II and III ducts united (thick arrow) lateral to umbilical portion (thin arrow); then, segment IV duct (arrowhead) joined medially to umbilical portion. (b) Three-dimensional portocholangiogram obtained in a 50-year-old man shows craniocaudal view of portobiliary systems. Segment II and III ducts united (thick arrow) just above umbilical portion (thin arrow); then, segment IV duct (arrowhead) joined medially to umbilical portion.

View larger version (81K): [in a new window]   Figure 3. Bile duct cancer in a 56-year-old man. Three-dimensional portocholangiogram shows craniocaudal view of portobiliary systems. Segment IV duct joined at a point close to the hepatic hilum. Arrow points to umbilical portion. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1.

View larger version (96K): [in a new window]   Figure 4a. Bile duct cancer in a 74-year-old woman. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1. (a) Three-dimensional portocholangiogram shows caudocranial view of portobiliary systems. Left lateral ducts crossed umbilical portion (thin arrow) cranially, and left biliary duct (thick arrow) coursed anterior to transverse portion. (b) Three-dimensional portocholangiogram shows craniocaudal view of portobiliary systems. Segment III and IV ducts united medially to umbilical portion (arrow); then segment II duct and segment I duct (B1) joined close to hepatic hilum.

View larger version (96K): [in a new window]   Figure 4b. Bile duct cancer in a 74-year-old woman. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1. (a) Three-dimensional portocholangiogram shows caudocranial view of portobiliary systems. Left lateral ducts crossed umbilical portion (thin arrow) cranially, and left biliary duct (thick arrow) coursed anterior to transverse portion. (b) Three-dimensional portocholangiogram shows craniocaudal view of portobiliary systems. Segment III and IV ducts united medially to umbilical portion (arrow); then segment II duct and segment I duct (B1) joined close to hepatic hilum.

View larger version (57K): [in a new window]   Figure 5a. Bile duct cancer in a 65-year-old woman. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1. (a) Three-dimensional portocholangiogram shows caudocranial view of portobiliary systems. Two segment IV ducts joined (arrow) medially to umbilical portion. (b) Three-dimensional portocholangiogram shows craniocaudal view of portobiliary systems. Segments II-IV immediately united (arrow) medially to umbilical portion.

View larger version (61K): [in a new window]   Figure 5b. Bile duct cancer in a 65-year-old woman. D = dorsal direction, V = ventral direction. Other keys are the same as for Figure 1. (a) Three-dimensional portocholangiogram shows caudocranial view of portobiliary systems. Two segment IV ducts joined (arrow) medially to umbilical portion. (b) Three-dimensional portocholangiogram shows craniocaudal view of portobiliary systems. Segments II-IV immediately united (arrow) medially to umbilical portion.