EURORAD ESR

Case 9325

Mesohepatectomy for solitary liver metastasis from clear cell renal carcinoma

Author(s)
Calcagni F, Grigolini A, Desideri I, Gherarducci G, Di Giambattista A, Ferrari V, Carbone M, Cappelli C, Bartolozzi C
 
Patient
female, 49 year(s)
 
 
  • Figure 1
    Contrast-enhanced CT
     

    Hypervascular hepatic lesion (4 cm in diameter) in the IV and VIII segments, adjacent to the portal bifurcation and biliary confluence.

     
    Area of Interest: Abdomen;

    Dimensional increase of the lesion (5 cm in diameter).

     
    Area of Interest: Abdomen;
     
     
  • Figure 2
    Contrast-enhanced CT
     

    MinIP reformation demonstrates dilatation of biliary tract in the right lobe but not in the left lobe.

     
    Area of Interest: Abdomen;

    A portion of hypervascular solid metastatic lesion enters the biliary confluence (b) and the proximal tract of the common bile duct (c).

     
    Area of Interest: Abdomen;

    A portion of hypervascular solid metastatic lesion enters the biliary confluence (b) and the proximal tract of the common bile duct (c).

     
    Area of Interest: Abdomen;

    Absence of dilatation of left biliary tree because of persistence of a thin communication between left biliary ducts and common hepatic duct.

     
    Area of Interest: Abdomen;
     
     
  • Figure 3
    MRCP
     

    MIP reconstructions confirm the dilatation of biliary tract in the right lobe and the thin communication between left biliary ducts and common hepatic duct.

     
    Area of Interest: Abdomen;

    MIP reconstructions confirm the dilatation of biliary tract in the right lobe and the thin communication between left biliary ducts and common hepatic duct.

     
    Area of Interest: Abdomen;
     
     
  • Figure 4
    CT postprocessing: vascular anatomy
     

    MIP reformations show vascular anatomy: right hepatic artery originates from superior mesenteric artery and gives origin to three distal branches for the VIII, VII and VI segment (that gives ramifications for the V...

     
    Area of Interest: Abdomen;

    MIP reformations show vascular anatomy: right hepatic artery originates from superior mesenteric artery and gives origin to three distal branches for the VIII, VII and VI segment (that gives ramifications for the V...

     
    Area of Interest: Abdomen;

    3D model shows vascular anatomy: right hepatic artery originates from superior mesenteric artery and gives origin to three distal branches for the VIII, VII and VI segment (that gives ramifications for the V segment),...

     
    Area of Interest: Abdomen;
     
     
  • Figure 5
    CT postprocessing: 3D model
     

    3D model developed by ENDOCAS- Center for computer assisted surgery (Cisanello Hospital, Pisa). Simultaneous visualisation of all vascular structures, hepatic parenchyma and metastatic lesion.

     
    Area of Interest: Abdomen;

    Separate visualisation of different structures: image b shows the relationship between the arterial and portal structures and image c demonstrates the contiguity of metastatic lesion to portal bifurcation and right...

     
    Area of Interest: Abdomen;

    Separate visualisation of different structures: image b shows the relationship between the arterial and portal structures and image c demonstrates the contiguity of metastatic lesion to portal bifurcation and right...

     
    Area of Interest: Abdomen;

    3D model allows to simulate the surgical resection in order to obtain the residual parenchymal volume.

     
    Area of Interest: Abdomen;
     
     
  • Figure 6
    Surgery: schemes and intraoperative images
     

    Type of central hepatectomy performed in our case (segments removed are displayed in gray tone).

     
    Area of Interest: Liver;

    Operative field of mesohepatectomy with resection of segments IV and VIII en bloc with biliary carrefour, proximal main bile duct and cholecystectomy.

     
    Area of Interest: Abdomen;

    Jejunostomy with single left bile duct and two right bile ducts. At histology, the resection margin was not infiltrated.

     
    Area of Interest: Abdomen;

    Possible types of central hepatectomy.

     
    Area of Interest: Liver;
     
     
  • Figure 7
    Postoperative contrast-enhanced CT
     

    Follow-up 4 months after surgery. Central gap of the liver and remaining segments. Some bowel loops needed for the biliary anastomosis are in the resected area.

     
    Area of Interest: Abdomen;

    Follow-up 4 months after surgery. Central gap of the liver and remaining segments. Some bowel loops needed for the biliary anastomosis are in the resected area.

     
    Area of Interest: Abdomen;

    Follow-up 4 months after surgery. Central gap of the liver and remaining segments. Some bowel loops needed for the biliary anastomosis are in the resected area.

     
    Area of Interest: Abdomen;
     
     
Hypervascular hepatic lesion (4 cm in diameter) in the IV and VIII segments, adjacent to the portal bifurcation and biliary confluence.
 
Dimensional increase of the lesion (5 cm in diameter).
 
MinIP reformation demonstrates dilatation of biliary tract in the right lobe but not in the left lobe.
 
A portion of hypervascular solid metastatic lesion enters the biliary confluence (b) and the proximal tract of the common bile duct (c).
 
A portion of hypervascular solid metastatic lesion enters the biliary confluence (b) and the proximal tract of the common bile duct (c).
 
Absence of dilatation of left biliary tree because of persistence of a thin communication between left biliary ducts and common hepatic duct.
 
MIP reconstructions confirm the dilatation of biliary tract in the right lobe and the thin communication between left biliary ducts and common hepatic duct.
 
MIP reconstructions confirm the dilatation of biliary tract in the right lobe and the thin communication between left biliary ducts and common hepatic duct.
 
MIP reformations show vascular anatomy: right hepatic artery originates from superior mesenteric artery and gives origin to three distal branches for the VIII, VII and VI segment (that gives ramifications for the V segment), respectively.
 
MIP reformations show vascular anatomy: right hepatic artery originates from superior mesenteric artery and gives origin to three distal branches for the VIII, VII and VI segment (that gives ramifications for the V segment), respectively.
 
3D model shows vascular anatomy: right hepatic artery originates from superior mesenteric artery and gives origin to three distal branches for the VIII, VII and VI segment (that gives ramifications for the V segment), respectively.
 
3D model developed by ENDOCAS- Center for computer assisted surgery (Cisanello Hospital, Pisa). Simultaneous visualisation of all vascular structures, hepatic parenchyma and metastatic lesion.
 
Separate visualisation of different structures: image b shows the relationship between the arterial and portal structures and image c demonstrates the contiguity of metastatic lesion to portal bifurcation and right anterior branch.
 
Separate visualisation of different structures: image b shows the relationship between the arterial and portal structures and image c demonstrates the contiguity of metastatic lesion to portal bifurcation and right anterior branch.
 
3D model allows to simulate the surgical resection in order to obtain the residual parenchymal volume.
 
Type of central hepatectomy performed in our case (segments removed are displayed in gray tone).
 
Operative field of mesohepatectomy with resection of segments IV and VIII en bloc with biliary carrefour, proximal main bile duct and cholecystectomy.
 
Jejunostomy with single left bile duct and two right bile ducts. At histology, the resection margin was not infiltrated.
 
Possible types of central hepatectomy.
 
Follow-up 4 months after surgery. Central gap of the liver and remaining segments. Some bowel loops needed for the biliary anastomosis are in the resected area.
 
Follow-up 4 months after surgery. Central gap of the liver and remaining segments. Some bowel loops needed for the biliary anastomosis are in the resected area.
 
Follow-up 4 months after surgery. Central gap of the liver and remaining segments. Some bowel loops needed for the biliary anastomosis are in the resected area.
 
 
 
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