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Digestive and Liver Disease xxx (xxxx) xxx

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Digestive and Liver Disease

journal homepage: www.elsevier.com/locate/dld

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- Digestive and Liver Disease

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Collateral intrahepatic circulation in presence of hepatic veins obstruction: The “half-moon”

Pietro Addeo*, Philippe Bachellier

Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France

Primary or metastatic liver tumors might involve the hepatic veins. Hepatic vein occlusion is generally caused by direct tu- moral invasion and/or tumoral thrombosis. The progressive instau- ration of venous occlusion enhances the development of an in- traparenchymal collateral circulation between the hepatic veins. These intrahepatic venous anastomoses already exist in normal liv- ers and involve the middle hepatic vein in 30% of cases [1,2]. These collateral veins can provide optimal outflow drainage to part of the liver which has an obstructed hepatic vein and an intact portal and

arterial inflow. These veins are mostly located inside the inferior right liver segments where these have a “half-moon knife” appear- ance and connect the middle and the right hepatic veins [2]. Pre- operative radiologic identification of these veins should systemat- ically drive clinicians to look for venous obstruction. During liver surgery section of these veins can be associated with major bleed- ing and haemodynamic intraoperative variations. The knowledge of this radiologic sign is of great help in the daily practice of liver sur- geons when planning procedures Figs. 1 and 2.

* Corresponding author. E-mail address: Pietrofrancesco.addeo@chru-strasbourg.fr (P. Addeo).

Fig 1. Preoperative CT scan of patient with adrenocortical carcinoma with "half-moon" sign (arrow) due to tumoral thrombosis of the right hepatic vein (dotted arrow) (A, B). Collateral circulation is provided through the origin of the middle hepatic vein right-to-left to drain the right liver (C, D). RHV=right hepatic vein; MHV=middle hepatic vein; LHV=left hepatic vein.

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ARTICLE IN PRESS

P. Addeo and P. Bachellier/ Digestive and Liver Disease xxx (xxxx) xxx

Fig. 2. Preoperative CT scan of patient with intrahepatic cholangiocarcinoma with "half-moon" sign (arrow) due to tumoral obstruction of the middle hepatic vein (dotted arrow) (A, B). Collateral circulation is provided through the origin of the middle hepatic vein left-to-right to drain the left liver(C, D). RHV=right hepatic vein; MHV=middle hepatic vein; LHV=left hepatic vein.

.5 130f

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Épaise 58’

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167.6 mm

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Declaration of Competing Interest

None.

References

[1] Barbier L, Ronot M, Monsinjon M, Paradis V, Soubrane O, Vilgrain V, Bel- ghiti J. Development of Collateral Pathways in Tumor Obstruction of Conflu-

ence of the Hepatic Veins: neither Fortuitous nor Innocuous. J Am Coll Surg Oct 2016;223(4):595-601.

[2] Hribernik M, Trotovšek B. Intrahepatic venous anastomoses with a focus on the middle hepatic vein anastomoses in normal human livers: anatomical study on liver corrosion casts. Surg Radiol Anat Apr 2014;36(3):231-7 Epub 2013. doi:10. 1007/s00276-013-1198-x.