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The Phrenic Nerves, Diaphragm and Pericardium.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Sometimes the ultrasound beam may 'catch' the dome of the diaphragm twice, particularly if it undulates or is partially 'eventrated' or 'inverted', and it may then appear 'double'. A double echo may also be given by the diaphragm and the base of the lung, when there is a thin intervening subpulmonary effusion. This is usually readily differentiated, as is a subdiaphragmatic fluid collection, but some difficulty may be experienced if fluid or an abscess lies above the 'bare area of the liver'.
Surgery for biliary atresia: Open and laparoscopic
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Mark Davenport, Atsuyuki Yamataka
The liver should be mobilized and everted onto the abdominal wall (Figure 55.8). This can be achieved by dividing the falciform ligament and left coronary ligaments. The right-sided attachments around the “bare” area of the liver can be left intact and the liver still everted. The authors believe this to be a crucial step, which allows full exposure of the portal hepatis and facilitates the subsequent detailed dissection. Nonetheless, it is possible to dissect the porta with the liver in situ although most proponents will sling the portal vessels to achieve the visualization of the portal plate. It is imperative to warn the anesthetist at this stage as the maneuver impairs venous return to the heart by kinking the cava and will need an increase in IV volume support.
Gastrointestinal and hepatobiliary
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Are the following statements true or false? Embryologically, the ventral pancreatic bud forms the head and uncinate pancreas.The inferior rectal vein drains into the inferior mesenteric vein.The cystic duct normally lies posterior to the common hepatic duct.The bare area of the liver is bounded by the triangular ligaments.The ureter lies medial to the duct for the vas deferens on the posterior aspect of the bladder.
High-intensity focused ultrasound ablation of liver tumors in difficult locations
Published in International Journal of Hyperthermia, 2021
Simon H. Tsang, Ka Wing Ma, Wong Hoi She, Ferdinand Chu, Vince Lau, Shuk Wan Lam, Tan To Cheung, Chung Mau Lo
The creation of an artificial pleural effusion to improve visualization of the liver dome by means of instillation of fluid into the right pleural cavity was described by Shibata et al. [26] in 2002 when performing percutaneous RFA. Fluid in the right pleural cavity provides an acoustic window where even the bare area of the liver, which is in direct contact with the diaphragm and not lined with peritoneum, can be visualized by ultrasound via the intercostal approach. When performing radiofrequency ablations on a series of 25 liver dome tumors, Koda et al. found that artificial pleural effusion allowed the operator to visualize the whole tumor on gray-scale sonography in 22 lesions that were not detectable or were poorly visible, and to obtain a safer and easier puncture line in 14 lesions [27]. A large series of percutaneous RFA of liver dome lesions assisted by artificial pleural effusion on 587 patients demonstrated that hydrothorax could safely be achieved without any increase in major complication rate [28].