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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
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 tumoral invasion and/or tumoral thrombosis. The progressive
instauration of venous occlusion enhances the development of an intraparenchymal collateral
circulation between the hepatic veins. These intrahepatic venous anastomoses already
exist in normal livers and involve the middle hepatic vein in 30% of cases [
]. 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” appearance and connect the middle and the right hepatic veins
[
]. Preoperative radiologic identification of these veins should systematically drive
clinicians to look for venous obstruction. During liver surgery section of these veins
can be associated with major bleeding and haemodynamic intraoperative variations.
The knowledge of this radiologic sign is of great help in the daily practice of liver
surgeons when planning procedures Figs. 1 and 2.
Fig 1Preoperative 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.
Fig. 2Preoperative 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.
