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The Kidney (KI)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
This sickle-shaped ligament attaches the liver to the ventral body wall. An embryologic remnant of the ventral mesentery, the falciform ligament denotes the separation of the most caudal portion of the left liver lobe into medial and lateral segments. The ligament attaches to the deep surface of the rectus abdominis as far down as the umbilicus. This explains the appearance of the ligament at KI 17 but not KI 16 caudal. It comprises two mesothelial layers of peritoneum filled with extra-peritoneal fat; the free edge houses the embryonic remnant of the ligamentum teres hepatis (obliterated left umbilical vein), muscular fibers, and paraumbilical veins. These vessels may re-open in patients with portal hypertension, as the congestion in the liver purses venous blood toward the abdominal wall and into previously dormant vascular pathways. The falciform ligament receives its blood supply from the left phrenic artery and a branch of the middle segment artery of the liver.5 Venous blood from the falciform drains into the left inferior phrenic vein. The paraumbilical veins together with the umbilical vein create an accessory portal system in communication with the systemic venous system. The inferior epigastric veins connect to the paraumbilical veins (of Burrow).
Doppler in Portal Hypertension
Published in Swati Goyal, Essentials of Abdomino-Pelvic Sonography, 2018
Criteria of portal hypertension Increase in PV size >13 millimetersIncrease in portal pressure >11 millimeters HgLoss of normal respiratory/phasic variation in diameter of PV, SMVHepatoFUGAL flowDilated and tortuous SMV, SV, and HARecanalization of paraumbilical vein (Figure 34.2)Cavernous transformation—Multiple small vessels at the portaCollateral formation—Paraumbilical (caput medusae), epigastric, splenorenal, hemorrhoidal, paraesophageal, and gastroesophagealLow PV flow velocity <10 centimeters per second (low spectral trace)SplenomegalyFlow may be—Monophasic—Antegrade/retrogradeBiphasic—Retrograde during inspiration,antegrade during expirationPresence of thrombus—Acute (anechoic, may be overlooked without Doppler) and chronic (hyperechoic) (Figure 34.3)
Diffuse large B cell lymphoma primarily presenting as acute liver failure in a surviving patient
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Jumpei Shibata, Shingo Kurahashi, Takehito Naito, Isamu Sugiura
Ultrasonography of the right-upper quadrant revealed an atrophied ‘potato liver’ with massive ascites. Contrast-enhanced computed tomography (CT) showed significant prominent atrophy of the liver with a mixed density area, suggesting fatty infiltration or hyperplasia and splenomegaly (Figure 1(a)). CT also revealed a dilated paraumbilical vein, indicating collateral circulation, and lymphadenopathy involving the peri-portal vein (Figure 1(b)). There was no sign of thrombosis or tumor embolus into the portal and hepatic veins, but an enlarged left cervical lymph node and slightly thickened gastric wall were observed.