The caudate lobe (segment I) lies posterior to the hilum and anterior to the inferior vena cava (IVC) (Fig. Here another illustration of the functional segmental liver anatomy. Segment 4b. The division of the liver into independent units means that segments can be resected without damaging the remaining … The caudate lobe of the liver has portal blood supply and hepatic vein drainage independent of the remainder of the liver and may be differentially affected in liver pathologies. This is known as Cantlie's line. Clinic of Radiology, Institute of Anatomy, Clinic of Surgery, Kaunas University of Medicine, Lithuania, by Anna C. Botero and Steven M. Strasberg Ultrasonographic measurement of the caudate lobe can be used to generate hepatic indices that may indicate cirrhosis. The caudate lobe or segment I is located posteriorly. - Segment 1 (S1), or caudate lobe, in the strict sense of the word, which corresponds to the portion with left development - Segment 9 (S9), corresponding according to Couinaud [7] to the portion with right development - Caudate process, a small portion of parenchyma which represents the infer-omedian extension of segment 9. Pakistan It contains one or more hepatic veins which drain directly into the inferior vena cava (IVC). segment VI and VII, Right anterior sectionectomy Left inferior lateral. segment II and III. Segment 4a. However, our study reported the extremely rare cases with utmost hypertrophy of Spiegel lobe (68.4% of TLV) in case 1 and exceeding hypertrophy of paracaval portion and caudate processus (65.8% of TLV) in case 2. Clinical and anatomical basis for the classification of the structural parts of liver, Division of the Left Hemiliver in Man—Segments, Sectors, or Sections. The caudate lobe may be supplied by both right and left branches of the portal vein. Left superior lateral. SegmentI: Caudate lobe Bounded anteriorly and medially by the fissure for ligamentum venosum Segment II: Superior segment of the left lateral sector/section Bounded medially by falciformligament and inferiorly by plane of MPV, also known as the posterior lateral sector (Bismuth, FCAT) Liver Anatomy 3 Each segment has its own vascular inflow, outflow and biliary drainage. This lobe (segment 1) engulfs the inferior vena cava with a prominent fissure separating it from the left lobe proper, in which lies the obliterated ductus venosus. At the level of the splenic vein, which is below the level of the right portal vein, only the inferior segments are visible. Saulius Rutkauskas et al. Due to a different blood supply the caudate lobe is spared from the disease process and hypertrophied to compensate for the loss of normal liverparenchyma. The traditional morphological anatomy is based on the external appearance of the liver and does not show the internal features of vessels and biliary ducts branching, which are of obvious importance in hepatic surgery. The anatomy of the liver can be described using two different aspects: morphological anatomy and functional anatomy. At this level the right portal vein divides the right lobe of the liver into superior segments (VII and VIII) and the inferior segments (V and VI). Although segment IV is part of the left hemiliver, it is situated more to the right. This study describes the surgical anatomy and analyses the operative technique, results and postoperative morbidity of complete caudate lobectomy. caudate lobe lies deep in the liver, between the hepatic hila and the retrohepatic inferior vena cava (IVC), and is adjacent to the major hepatic veins in its upper part. The caudate lobe is anatomically different from other lobes in that it often has direct connections to the IVC through hepatic veins, that are separate from the main hepatic veins. The caudate lobe or segment I is located posteriorly. The French surgeon and anatomist Claude Couinaud was the first to divide the liver into eight functionally indepedent segments allowing resection of segments without damaging other segments. The level of the right portal vein is inferior to the level of the left portal vein. The caudate lobe (lobus caudatus; Spigelian lobe) is situated upon the posterior surface of the right lobe of the liver, opposite the tenth and eleventh thoracic vertebræ. [1], There are four lobes of the liver. Each segment has its own vascular inflow, outflow and biliary drainage. Left liver: lateral(II/III) vs medial segment (IVA/B) The caudate lobe is anatomically different from other lobes: It hase direct connections to the IVC through hepatic veins It may be supplied by both right and left branches of the portal vein. The caudate lobe of the liver is a frequent site of involvement by metastatic or primary liver tumours. [7], Segments V to VIII make up the right part of the liver:[3], The fissure for the round ligament of the liver (ligamentum teres) separates the medial and lateral parts of segment IV. Liver Size. [3] The division of the liver into independent units means that segments can be resected without damaging the remaining segments. Imaging characteristics include surface nodularity, atrophy of the right lobe and medial segment of the left lobe, enlargement of the caudate lobe and lateral segment of the left lobe, increased porta hepatis fat, and expansion of the gallbladder fossa . The illustration above is a schematic presentation of the liver segments. In the periphery of each segment there is vascular outflow through the hepatic veins. by DR TAHIR A SIDDIQUI ( consultant sonologist )Gujranwala. [2] In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct. The caudate-right lobe ratio may be useful in quantifying caudate hypertrophy. [5][6], Segments II and III lie lateral to the falciform ligament with II superior to the portal venous supply and III inferior. The caudate lobe was defined according to Kumon's subdivision system, and the boundary between the paracaval portion and segment 7 or 8 was investigated based on three-dimensional computed tomography scan images using SYNAPSE VINCENT®. Left inferior medial. Right hepatectomy Caudate lobe is usually referred as a silent liver reserve, accounting for approximately 2% to 3% of the total liver volume (TLV) [ 7 ]. Segment 1. According to Kumon’s classifi-cation, 12. Right hepatic vein divides the right lobe into anterior and posterior segments.Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). The caudate lobe (posterior hepatic segment I, Spigelian lobe) is located on the postero-superior surface of the liver in the right lobe of the liver, in front of the tenth and eleventh thoracic vertebrae. BACKGROUND: Laparoscopic hepatectomy for segment (S) 7 is classified as one of the most difficult procedures to perform.1 Here, we report a standardized method with the caudate lobe first approach2,3 which may benefit such difficult procedures. [1], The classification system uses the vascular supply in the liver to separate the functional segments (numbered .mw-parser-output .roman-numeral{font-family:"Nimbus Roman No9 L","Times New Roman",Times,serif;font-size:118%;line-height:1}.mw-parser-output .roman-numeral-a{border:1px solid}.mw-parser-output .roman-numeral-t{border-top:1px solid}.mw-parser-output .roman-numeral-v{border:solid;border-width:0 1px;padding:0 2px}.mw-parser-output .roman-numeral-h{border:solid;border-width:1px 0}.mw-parser-output .roman-numeral-tv{border:1px solid;border-bottom:none;padding:0 2px}I to VIII), Segment I is the caudate lobe and is situated posterior l. It may receive its supply from both the right and the left branches of portal vein. These are also known as hepatic segments that are surgically resectable. Caudate Lobe. The numbering of the segments is in a clockwise manner. located deeply behind the 3 hepatic veins and the hilar. van Leeuwen MS, Noordzij J, Hennipman A, Feldberg MA. Department of Radiology, University Hospital Utrecht, The Netherlands. Segment I (the caudate lobe) is located posteriorly. The oblique fissure extends from the gallbladder fossa to the IVC posteriorly. Extended Right or right trisectionectomysegment IV, V, VI, VII and VIII (± segment I). The Couinaud classification of liver anatomy then further divides the liver into eight functionally independent segments. The Couinaud classification of liver anatomy divides the liver into eight functionally indepedent segments. In the periphery of each segment there is vascular outflow through the hepatic veins. The caudate lobe is generally divided into the Spiegel lobe, the paracaval portion, and the caudate process (9) (Fig 1). [4] To preserve the viability of the liver following surgery, resections follow the vessels defining the peripheries of each segment. Department of Radiology and Surgery, University Hospital Utrecht, The Netherlands. Echogenic texture of the liver. On a normal frontal view the segments VI and VII are not visible because they are located more posteriorly. With cLC lobar or segmental changes combined with atrophy of the right lobe and medial segment together with hypertrophy of the caudate lobe and lateral segment are commonly seen. The numbering system starts with the caudate lobe (segment I, on the posterior of the liver and not seen in this image) and carried out in a clockwise fashion. Segment IV is subdivided into IVa and IVb, superior and inferior and is located between the left and middle hepatic veins. The caudate lobe (segment 1) is outlined by the transverse fissure anteriorly, the sagittal fissure at its left border, the oblique fissure on its right border, and the IVC posteriorly (Figure 1). The left and right portal veins branch superiorly and inferiorly to project into the center of each segment. The caudate lobe is anatomically different from other lobes in that it often has direct connections to the IVC through hepatic veins, that are separate from the main hepatic veins. There are eight liver segments. This figure is a transverse image through the superior liver segments, that are divided by the right and middle hepatic veins and the falciform ligament. Of note, segments VI and VII were drawn for the purpose of illustration. Extrapolate a line along the falciform ligament superiorly to the confluence of the left and middle hepatic veins at the IVC (blue line).Left vs Right liver: IVA/B vs V/VIII The Couinaud classification of liver anatomy then further divides the liver into eight functionally independent segments. Cantlie's line runs from the middle of the gallbladder fossa anteriorly to the inferior vena cava posteriorly. This CT-image is of a patient with liver cirrhosis with extreme atrophy of the right lobe, normal volume of the left lobe and hypertrophy of the caudate lobe. MS van Leeuwen, J Noordzij, MA Fernandez, A Hennipman, MA Feldberg and EH Dillon The inferior medial segment (IVb) is also called the quadrate lobe.[8]. Caudate lobe is the smallest segment of the liver and is. It is bounded, below, by the porta; on the right, by the fossa for the inferior vena cava; and, on the left, by the fossa for the ductus venosus. … The first is the left lobe, or Spiegel’s lobe (Couinaud’s segment 1), which is the main bulk of the caudate lobe and lies on the left side of the IVC and in the lesser omental bursa. Segment 2. In reality however the proportions are different. Considered enlarged when greater than 17.5cm high. [1], The caudate lobe is a separate structure which receives blood flow from both the right- and left-sided vascular branches. Hypertrophy of the caudate lobe is seen in a number of conditions, including: cirrhosis: most common; Budd-Chiari syndrome; primary sclerosing cholangitis (end stage) congenital hepatic fibrosis; cavernous transformation of the portal vein; Radiographic features. The caudate section of the liver is connected to the right lobe by a narrow bridge called the caudate The Caudate Lobe is located between the left lobe of the liver and the inferior vena cava. 22.1; see also Fig. Segment V is inferior to the portal … Small dorsal pedicles, which are quite numerous, arise from the posterior margin of the main portal elements, and ascend upward. This study investigated the relationship of metrics of the caudate lobe and other … Liver surface nodularity has … Segment II and III is the superior and inferior lateral left lobe. Left superior medial. Extended Left or left trisectionectomysegment II, III, IV, V and VIII (± segment I). Segment 3. Each segment has its own vascular inflow, outflow and biliary drainage. Segment IV is sometimes divided into segment IVa and IVb according to Bismuth. The periphery of each segment is where vascular outflow occurs via the hepatic veins. It receives portal venous, as well as hepatic arterial, blood from both branches of the aforementioned vessels. "Couinaud classification | Radiology Reference Article", "Liver Anatomy: Overview, Gross Anatomy, Microscopic Anatomy", "The Radiology Assistant : Anatomy of the liver segments", "Hepatic segments (Couinaud classification) / Radiological classifications commonly used on medical imaging / Radiology / Channels / e-Cases /", "Three-dimensional Anatomy of the Couinaud Liver Segments", https://en.wikipedia.org/w/index.php?title=Liver_segment&oldid=1010827186, Creative Commons Attribution-ShareAlike License, This page was last edited on 7 March 2021, at 15:11. A liver segment is one of eight segments of the liver as described in the widely used Couinaud classification (named after Claude Couinaud) in the anatomy of the liver. This system divides the lobes of the liver into eight segments based on a transverse plane through the bifurcation of the main portal vein. bounded posterolaterally by the fossa for the inferior vena cava, anteriorly by the ligamentum venosum, and inferiorly by the porta hepatis; its inferior portion is subdivided into a lateral caudate process and a medial papillary process 6; may receive its supply from both the right and the left portal vein The left portal vein is at a higher level than the right portal vein. It corresponds to the posterior part of the left medial division of the liver described as the caudate lobe. Extrapolate a line along the right hepatic vein from the IVC inferiorly to the lateral liver margin (green line). Segment I includes the caudate lobe, and segment IX is incorporated in the posterior surface of the right liver. segment V and VIII, Left lateral sectionectomy Unlike the liver's other lobes, the caudate lobe is directly connected to the IVC through small veins, known as heptic veins, which move deoxygenated blood. Left hepatectomysegment II, III and IV (± segment I). plate in front of the IVC. The Spiegel lobe is located below the lesser omentum and is seen as the protruding portion to the left of the IVC at CT (9). The right border of the liver is formed by segment V and VIII. The caudate lobe is predominantly to the left side of the cava and extends between the portal vein and vena cava to merge with the right lobe as the caudate process . Separates left lobe from the caudate lobe. There are four lobes of the liver. Nowadays, caudate lobe surgery remains a challenge to hepatobiliary surgery and has become a representation of technically demanding hepatobiliary surgeries. The caudate lobe may be supplied by both right and left branches of the portal vein. The caudate lobe, situated deeply in the liver, between the hepatic hila and inferior vena cava (IVC), is anatomically special which had made it hardly feasible to operate on it. This plane runs from the inferior vena cava to the gallbladder fossa.The Falciform ligament divides the left lobe into a medial- segment IV and a lateral part - segment II and III. segment 1 (I) is the caudate lobe . Liver Transplantation and Surgery, Vol 4, No 3 (May), 1998: pp 226-231, Appendicitis - Pitfalls in US and CT diagnosis, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, Multiple Sclerosis - Diagnosis and differential diagnosis, Developmental Dysplasia of the Hip - Ultrasound, How to separate liver segments on cross sectional imaging, Portal venous and segmental anatomy of the right hemiliver: observations based on three-dimensional spiral CT renderings. In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct. In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct. Segment IV lies medial to the falciform ligament and is subdivided into IVa (superior) and IVb (inferior). The eight liver segments described by Couinaud and Bismuth [3, 5] are numbered clockwise based on a frontal view of the liver beginning with the posterior superior segment of the left parame-dian sector, which corresponds to the caudate lobe, and ending with segment VIII which is consistent with the posterior superior segment of the right paramedian sector. It is drained drained by both right and left hepatic ducts. This image is at the level of the right portal vein. Eight segments by Couinaud labelled. Couinaud divided the liver into a functional left and right liver by a main portal scissurae containing the middle hepatic vein. Right posterior sectionectomy At this level the left portal vein divides the left lobe into the superior segments (II and IVa) and the inferior segments (III and IVb). The caudate lobe is a portion of the liver that extends medially from the right lobe between the inferior vena cava and the fissure for the ligamentum venosum. Segment I is the caudate lobe. Resection of the caudate lobe (segment I- dorsal sector, segment IX- right paracaval region, or both) is often technically difficult due to the lobe's location deep in the hepatic parenchyma and because it is adjacent to the major hepatic vessels (e.g., the left and middle hepatic veins). These veins are separate from the main heptic veins in the liver. The lobes of the liver are further divided into eight liver segments in the Couinaud system. A ratio of greater than 0.65 indicates a high likelihood of cirrhosis. The caudate lobe (segment I) is the autonomous zone of the liver. Planning of liver surgery using three dimensional imaging techniques. It is not visible on a frontal view. This means that resection lines parallel the hepatic veins, leaving the portal veins, bile ducts, and hepatic arteries intact. Many surgeons prefer to use the term "extended" instead of trisectionectomy to indicate that some adjacent tissue of segment 4, or 5/8, as applicable is included rather than the entire segment 4, or 5/8. This is a transverse image at the level of the left portal vein. In the periphery of each segment there is vascular outflow through the hepatic veins. segment V, VI, VII and VIII (± segment I). Extrapolate a line from the gallbladder fossa superiorly along the middle hepatic vein to the IVC (red line).Right liver: anterior (V/VIII) vs posterior segment (VI/VII) Shape of human liver in animation. The portal vein divides the liver into upper and lower segments. In the NAV, the caudate process and papillary process are included in a same lobe, the caudate lobe. Additionally, its biliary drainage is by both branches of the hepatic ducts and its venous return goes directly into the inferior vena cava.

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