Hepatic Venous Sonography

Some normal variations of the hepatic venous anatomy were studied on 103 healthy subjects using ultrasonography. An inferior right hepatic vein (IRHV) was found in 15.5% of cases. The intercostal coronal view was helpful to demonstrate this vessel. This is of importance to the surgeon performing a subtotal right hepatectomy. The middle hepatic vein, which forms the borderline between the right and left hepatic lobes was easily identified in 100% of cases that had three major superior hepatic veins. In 31% of cases, however, there were four or five superior hepatic veins, making distinction between right and left lobes more difficult. In this situation, the relationship between the superior right portal venous branch and the hepatic veins was found to be helpful in determining the division between right and left lobes. Since the superior right portal branch is always situated in the anterior segment of the right lobe, the hepatic vein medial to it was identified to be the middle hepatic vein.