Endoscopic ultrasound of the hepatoduodenal ligament and liver hilum

The porta hepatis and hepatoduodenal ligament (HDL) are important anatomical pathways of extension of disease to and from the liver. The imaging of this area is difficult. The role of endoscopic ultrasound (EUS) as an imaging modality for hepatoduodenal ligament has not been established so far. All images in the present study have been generated from a detailed review of real time recordings using the curved linear scanning echoendoscope EG -3830 UT (Pentax Corporation, Tokyo, Japan), coupled with a Hitachi avius and Hitach 7500 processor (Hitachi Aloka Medical, Tokyo Japan). Our image orientation is with the cranial aspect of the patient directed toward the right side of the screen. We have illustrated that with a careful technique, a detailed EUS evaluation of the HDL and hepatic hilum is possible. A thorough understanding of the HDL anatomy by curved linear EUS probe may play a crucial role in the accurate diagnosis of a broad spectrum of pathologic conditions of the porta hepatis. EUS examination of the HDL should be a part of the upper abdominal EUS studies. The description and the images described in this article are useful for beginners who want to start imaging of the porta hepatis and hepatoduodenal ligament. This information is useful for staging of malignancies involving common bile duct.