Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




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Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 731 - 733 Full Version

An Unusual Variant of the Portal Vein


Published: May 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2175
Y.C. Manjunatha, Y.C. Beeregowda, Bhaskaran A.

1. Department of Radiodiagnosis, Pondicherry Institute of Medical Sciences, Puducherry - 605 014, India. 2. Department of Paediatrics Sri Devaraj Urs Medical College, Tamaka, Kolar-563101, India. 3. Department of Surgery. Sri Devaraj Urs Medical College, Tamaka, Kolar-563101, India.

Correspondence Address :
Dr. Manjunatha YC.
Assistant Professor,
Department of Radiodiagnosis,
Pondicherry Institute of Medical Sciences,
Kalathumettupathai, Ganapathichettikulam, Village No.20
Kalapet, Puducherry - 605 014, India.
Phone: +91 9478026631.
E-mail: manjuyc@gmail.com

Abstract

The Portal Vein (PV) is formed by the selective involution of the vitelline veins. Any change in the anastomotic pattern of the vitelline veins during their development results in several PV variants. Knowledge on the normal anatomy and the portal vein variants is of great importance for liver surgeries and interventional procedures. We are reporting here the computed tomography features of an unusual variant of the portal vein in a patient with carcinoma of the gall bladder. In this patient, the main portal vein enters the right lobe of the liver and courses in to the left lobe, which gives only segmental branches along its course. As per our knowledge, only very few of such cases have been reported in the literature so far.

Keywords

Portal vein variant, Computed tomography, vitelline veins

Introduction
The Portal Vein conveys blood from the abdominal viscera and it branches like an artery in the liver and ends at the sinusoids. The tributaries of the portal vein are the splenic, superior mesenteric, left gastric, right gastric, paraumbilical, and the cystic veins. The portal vein (PV) is formed generally during 4-10 weeks of gestation by the selective involution of the vitelline veins. Any change in the anastomotic pattern of the vitelline veins during their development results in several PV variants. The congenital variants of the portal vein are total or partial agenesis of the portal vein, abnormal branching of the portal vein, arteriovenous malformations, and venous malposition (in situs inversus totalis). We are reporting here a rare portal vein variant in a patient with carcinoma of the gall bladder, in which a single portal vein enters the right lobe of the liver and courses in to the left lobe, while giving only segmental branches along its course. Knowledge on the PV variations helps in an accurate depiction of the cross sectional imaging and it reduces the complication rates of the surgical and the radiological interventional procedures.

Case Report

A 47-year old woman was admitted to our hospital with fever, pain in the right hypochondrium and jaundice. The jaundice was gradually increasing, with itching all over the body. On examination, she was found to have tachycardia (hear rate -98 beats/min), a raised body temperature (1030 F) and yellowish discolouration of the skin and mucous membranes. Her abdominal examination revealed a tender, soft swelling in the right hypochondrium. Her laboratory tests revealed a haemoglobin level of 8.5 gm%, a white cell count of 9200/cmm and ESR of 16 mm at 1 hour. Her transaminase levels were mildly raised. Her direct serum bilirubin level was raised significantly (16 mg %), along with her alkaline phosphatase level (519 IU). Her prothrombin time was normal.

Ultrasonography revealed a large, ill defined, soft tissue mass lesion in the neck of the gall bladder which was infiltrating into the porta, causing a moderate upstream dilatation of the intrahepatic biliary radicles. There was an unusual course of the main portal vein (PV) anterior to the pancreas and it entered the liver through the medial border of the segment V of the right lobe and coursed posterosuperiorly without any major branching. The hepatic artery and the common duct were at normal locations. A diagnosis of carcinoma of the gall bladder with infiltration of the porta, which caused moderate dilatation of the intrahepatic biliary radicals, cholangitis and a portal vein variant, was made. An emergency percutaneous transhepatic biliary drainage was performed. CT (computed tomography) scan showed a large, ill defined, infiltrating mass lesion which arose from the neck of the gall bladder, which involved the common duct and caused moderate dilatation of the intrahepatic biliary radicals (Table/Fig 1A). The confluence of the portal vein was seen anterior to the neck of the pancreas and the portal vein entered the liver at the anterior aspect of the medial border of the segment V of the right lobe (Table/Fig 1A) and (Table/Fig 1B). The portal vein coursed posterosuperiorly into the left lobe without any major branching, but giving only the segmental branches (Table/Fig 2A) and (Table/Fig 2B). The anatomy of the coeliac axis and the hepatic artery and its branches was unremarkable. Ultrasound guided fine needle aspiration cytology of the gall bladder mass confirmed the diagnosis of carcinoma of the gall bladder.

Discussion

The portal vein (PV) is formed generally during 4-10 weeks of gestation by the selective involution of the vitelline veins. The vitelline veins are multiple bridging anastomoses which are present anterior and posterior to the duodenum. Any change in the anastomotic pattern of the vitelline veins during their development results in several PV variants (1).

The most common branching pattern of the portal vein is that it divides at the porta hepatis into the right and the left portal veins. The right portal vein first gives off branches to the caudate lobe and then it divides into the anterior and posterior branches, which further subdivide into the superior and inferior segmental branches to supply the right lobe of the liver. The left portal vein first has a horizontal course to the left and then it turns medially towards the ligamentum teres, supplying the lateral segments (segments II and III) of the left lobe.

The prevalence of the PV variants ranges from 28 to 35 % (2), (3), the common variants being a trifurcation or the right posterior portal vein as the first branch of the main portal vein (22%) and a single posterior segment branch arising as the first branch of the right portal vein (7%) (1),(4). Few rare portal vein variants which have been reported are duplication, quadrification and congenital absence of the PV and an accessory PV. Another rare variant includes a single portal vein entering the right lobe of the liver and coursing into the left lobe, which gives only segmental branches along its course, as was seen in our case (1), (5), (6), (7).

Accurate assessment of the arterial and venous anatomy is increasingly important while plans are made for various liver surgeries and percutaneous interventional procedures. The procedures which require a thorough knowledge of the anatomy of the portal vein and its variants include liver resections, transhepatic portal vein embolization and transjugular intrahepatic portosystemic shunts (TIPS). Biphasic CT or MRI in the arterial and portovenous phases will correctly determine the vascular anatomic variations, aided by multiplanar reconstruction (MPR), maximum intensity projection images (MIP) and volume rendered (VR) 3D images (1), (3).

Conclusion

The portal vein variants are asymptomatic, but the knowledge on the normal portal venous anatomy, normal variations and congenital anomalies helps in an accurate depiction on the cross sectional imaging. These variants can be better demonstrated in detail by multislice CT scan with 3D reconstruction. Awareness on the portal vein variations critically reduce the complication rates of the surgical and radiological interventional procedures.

References

1.
Covey AM, Brody LA, Getrajdman GI, Sofocleous CT, Brown KT. Incidence, patterns, and clinical relevance of variant portal vein anatomy. AJR Am J Roentgenol. 2004 Oct;183(4):1055-64.
2.
Erbay N, Raptopoulos V, Pomfret EA, Kamel IR, Kruskal JB. Living donor liver transplantation in adults: vascular variants are important in the surgical planning for donors and recipients. AJR Am J Roentgenol 2003; 181:109-14.
3.
Koç Z, Ouzkurt L, Ulusan S. Portal vein variations: clinical implications and frequencies in routine abdominal multidetector CT. Diagn Interv Radiol. 2007 Jun;13(2):75-80.
4.
Atasoy C, Ozyurek E. Prevalence and types of the main and right portal vein branching variations on MDCT. AJR Am J Roentgenol 2006; 187:676-81.
5.
Gallego C, Velasco M, Marcuello P, Tejedor D, De Campo L, Friera A. Congenital and acquired anomalies of the portal venous system. Radiographics 2002; 22:141-59.
6.
Baba Y, Hokotate H, Nishi H, Inoue H, Nakajo M. Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr 2000; 24:802-08.
7.
Pomfret EA, Pomposelli JJ, Lewis WD, et al. Doing live donor adult liver transplantation by using right lobe grafts: the donor evaluation and the surgical outcome. Arch Surg 2001; 136:425–33.

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ID: JCDR/2012/3862:0051

Date of Submission: Dec 26, 2011
Date of peer review: Mar 08, 2012
Date of acceptance: Mar 29, 2012
Date of Publishing: May 31, 2012

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