Liver

Liver
The liver has many functions

Metabolism
Digestion
Storage
Detoxification

See box 6-2 in your book

page 151 for summary of
liver functions

Liver
Largest organ in the body
Intraperitoneal in location
Occupies a major portion of the right
hypochondrium
Lies inferior to the diaphragm
Suspended from the diaphragm and the
anterior abdominal wall by the falciform
ligament

Liver
Most of the liver is covered by the
peritoneum

A large area rests directly on the diaphragm

and is not covered by the peritoneum and is
called the bare area

Subphrenic space the space between the

liver and diaphragm that can be a sight of
abscess formation

Liver
Anatomy

Glissons capsule a tight, fibrous capsule

that encloses the liver and the portal triad
throughout the liver

Liver Anatomy
3 (4) Lobes

Right
Left
Cuadate
(Quadrate)

Some textbooks will describe

4 liver lobes, with the quadrate
lobe being the 4th.

Liver Anatomy
Right Lobe

Largest lobe in the normal adult liver

Normal = 13cm or less, may also see 15-17
cm
Normal = the inferior tip of the right lobe does
not extend below the lower pole of the right
kidney
Occupies the right hypochondrium
Divided into anterior and posterior sections by
the right hepatic vein

Liver Anatomy
Right Lobe

Liver Anatomy

Rt hepatic vein dividing right lobe into posterior

and anterior segments

Liver Anatomy
Right Lobe (cont)

Reidels Lobe normal variant of the right

lobe
Tonguelike inferior extension of the right lobe
May extend as far caudally as the iliac crest
Identified when the liver tissue extends well below
the inferior pole of the right kidney
Will have the same sonographic appearance as
the rest of the liver
Most commonly seen in women

Liver Anatomy
Right Lobe (cont)

Reidels Lobe

Normal liver and kidney

Normal variant Reidels Lobe

Liver Anatomy
Left Lobe

Varied in size
Lies in the epigastric and left hypochondriac
regions
Divided into lateral and medial segments by
the left hepatic vein

Liver Anatomy
Left Lobe

Liver Anatomy

Lt hepatic vein dividing left lobe into medial

and lateral segements

Liver Anatomy
Caudate Lobe

Small, but significant piece of liver anatomy

Varies in size
Posterior portion of the liver
Lies anterior to the IVC and posterior ligamentum
venosum

Liver Anatomy
Caudate Lobe

Liver Anatomy
Caudate Lobe (cont)

Ligamentum venosum is a the remnant of

the fetal ductal venosus, a branch of the
umbilical vein that shunts blood through the
liver to the IVC

Liver Anatomy
Quadrate Lobe

Some anatomy books refer to this as the 4 th lobe of the liver

Located between the gallbladder and IVC
Sometimes referred to as part of the left lobe

Hepatic Nomenclature
Courinauds System of hepatic
nomenclature provides the anatomic basis
for hepatic surgical resection
Allows the radiologist to precisely isolate
the location of lesions for the surgical
team
8 segments based on hepatic and portal
venous segments

Hepatic Nomenclature
Courinauds System

Liver segments are based on the portal and

hepatic venous segments

Ligaments and Fissures

Several important ligaments and fissures

Main lobar fissure

Falciform ligament
Ligamentum teres (round ligament)
Ligamentum venosum
These structures appear echogenic due to
collagen and fat within and around them

Main Lobar Fissure

Boundary between the right and left lobes
in Courinauds sections
Appears as an echogenic line extending
from the portal vein to the neck of the
gallbladder
Used as a landmark to locate the
gallbladder when contracted or filled with
stones

Main Lobar Fissure

Falciform Ligament
Divides the right and the left lobes
Extends from the umbilicus to the
diaphragm
Contains the ligamentum teres

Falciform Ligament

Ligamentum Teres
Remnant of the portal sinus
in fetal circulation
Seen as the rounded
termination of the falciform
ligament

Transverse image of left

lobe demonstrating the
ligamentum teres

Ligamentum Venousum
Separates the left lobe from the caudate
lobe
Seen as an echogenic linear line anterior
to the caudate lobe
Remnant of the ductus venosus in fetal
circulation

Ligamentum Venousum

Liver
Fetal Liver

See handout

-After birth the ductus venosum becomes the

ligamentum venosum
-After birth the portal sinus becomes the
ligamentum teres
-These are landmarks in liver sonography

Portal Veins
Decrease in size as they approach the
diaphragm
Course within the segments of the liver
(intrasegmental)

Portal Veins
Main portal vein

Enters the liver and then divides into two

branches:
Right portal vein
Left portal vein

Portal Veins
Main Portal Vein

Portal Veins
The main portal vein divides into the right portal
vein and the left portal vein

Portal Veins
Right Portal Vein

Larger of the two branches

Divides into anterior and posterior

branches

Portal Veins
The right portal vein bifurcates into the anterior right portal
vein and the posterior right portal vein

Portal Veins
Left Portal Vein

Divides into medial and lateral branches

Hepatic Veins
3 components

Right
Middle
Left

Increase in size as they approach the

diaphragm and the IVC
Used sonographically to separate the liver
into segments

Hepatic Veins

Liver
Sonographic appearance:

Homogeneous

Moderately echogenic

Liver Protocol
Usually fasting 8-12 hours but not
necessary if liver is the only area of
interest
Pt position Supine, LPO or Decub
3-5 MHz Transducer
Breathing technique Deep inspiration
held

Longitudinal Survey
Left Lobe with aorta

Longitudinal Survey
Left Lobe with diaphragm and caudate lobe

Longitudinal Survey
Right Lobe with the IVC

Longitudinal Survey
Right lobe including main lobar fissure, gallbladder
and portal vein

Longitudinal Survey
Right lobe to include right kidney for
parenchyma comparison

Longitudinal Survey
Right lobe and dome of diaphragm, including
the pleural space

Longitudinal Survey
Some protocols may require a liver measurement
while other protocols ask sonographers to measure
the liver if it appears enlarged

Transverse Survey
Left lobe including the lateral margin

Transverse Survey
Left lobe with ligamentum teres

Transverse Survey
Right lobe with hepatic veins

Transverse Survey

Right lobe with hepatic veins

Transverse Survey
Right lobe with portal veins

Transverse Survey
Right lateral inferior lobe with kidney

Transverse Survey
Right lobe with diaphragm and pleural space

Assignments
There will be a quiz next Wednesday over
todays material
Review for Midterm review next week
To prepare for Class on October 14 th

Read pages 203-214 (to Pathology of.)

References
Textbook of Diagnostic Ultrasonography
6th edition; Hagen-Ansert.