AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US),CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT sca...AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US),CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US,CT and angiography were also reviewed. RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies,absence of umbilical portion of the portal vein in the left lobe of the liver,club-shaped portal vein in the right lobe of the liver,and difficulty in identifying segment Ⅳ. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment Ⅳ artery was identified in four of six patients using angiography,although segment Ⅳ was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively. CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US,CT and angiography images that demonstrate no definite segment Ⅳ,absence of umbilical portion of the portal vein in the left lobe,and club-shaped right anterior portal vein.展开更多
基金Supported by Project Grant NHRI-GT-EX92-9228SP from the National Health Research Institutes and NSC 93-2314-B-182A-084 from the National Science Council, Taiwan, China
文摘AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US),CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US,CT and angiography were also reviewed. RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies,absence of umbilical portion of the portal vein in the left lobe of the liver,club-shaped portal vein in the right lobe of the liver,and difficulty in identifying segment Ⅳ. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment Ⅳ artery was identified in four of six patients using angiography,although segment Ⅳ was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively. CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US,CT and angiography images that demonstrate no definite segment Ⅳ,absence of umbilical portion of the portal vein in the left lobe,and club-shaped right anterior portal vein.
