Roentgen Demonstration of the Venous Circulation in the Liver: Portal Venography

Abstract

Vasography has proved to be one of the most fruitful fields of roentgen investigation in recent years. With the hope of further extending its scope, a study of the roentgen demonstration of the portal circulation of the liver has been instituted at the University of Minnesota. This demonstration has been given the descriptive designation portal venography. The literature contains several references to portal venography, but these are concerned for the most part with the extra-hepatic portal system. Little interest has been evidenced in the intrahepatic portal circulation, which is the subject of this paper. Due to its relative inaccessibility, the various methods of approach to the portal circulation present difficulties from a diagnostic standpoint. An external approach is possible under certain specialized circumstances, such as a pre-existing portacaval anastomosis or portal obstruction with secondary dilatation of the periumbilical veins. The great majority of cases, however, require an internal approach which necessitates laparotomy. Using an external approach, Farinas obtained good contrast filling of the portal vein and the portal radicles within the liver by means of contrast material injected into the long saphenous vein in cases where a portacaval anastomosis was present. More recently Dotter and his co-workers were able to pass a catheter directly into the portal vein through a portacaval anastomosis. This external approach resulted in a visualization of the portal radicles similar to that obtained by Fariñas. In the presence of portal obstruction with concomitant dilatation of the periumbilical veins, Celis and his associates visualized the portal circulation by means of contrast material injected into these dilated veins. Blakemore and Lord have used an internal approach to portal venography at operation to demonstrate the site of extrahepatic portal obstruction. Child et al. have also used operative portal venography in their studies of the effects of complete occlusion of the portal vein and have satisfactorily demonstrated the extrahepatic portal system. In evaluating the problems of portal venography precise information concerning the anatomy and dynamics of the portal circulation is desirable. On the basis of the study of 92 autopsy cases Douglass, Baggenstoss and Hollinshead present a diagram of the most constant configuration of the extrahepatic portal system (Fig. 1). The work of these authors probably represents the most reliable data on this subject available at the present time, since the diagrams of the portal system found in most standard texts and atlases of anatomy were made from a single dissection. The intrahepatic circulation is well described by McIndoe in his paper on the vascular lesions of portal cirrhosis. McIndoe prepared for study a number of corrosion specimens of the vascular tree in both normal and cirrhotic livers.