Aims and objectives
Couinaud defined a segmental description of the liver in order to define clear surgical planes for resections (1).
Segment IV (quadrate lobe) derives from the middle part of the cranial bud of the hepatic diverticulum which joins the left bud to the right one and which receives the embryonic middle hepatic artery (2); thus this segment occupies the center of the liver. After right hemi-liver resection,
segment IV is left in place and accounts for almost 40% of the remnant liver.
Methods and materials
We conducteda retrospective study in which we reviewed pre-existing 1000 CT angiograms collected between May 2008 and July 2010 in the imaging department of Habib Bourguiba Hospital in Sfax-Tunisia.
All CT angiograms were previously performed for medical diagnosis purposes.
Agreement of the local ethics committee has been obtained for this study. Inclusion criteria: We enrolled all CT angiographies including an arterial phase exploring the liver arterial vasculature with at least enhancement...
Segment IV arteries were well identified in 895 cases (89.5 %).
The remaining 105 cases were excluded because it was difficult to accurately determine the origin of segment IV hepatic artery. Among the 895 cases,
the liver received a single artery (CHA) in 72.1 %.
When the liver received more than one artery,
LHA-RHA and CHA-LHA-RHA patterns were noted in 49.2,
2.8 and 12 % of cases respectively ( Fig. 1 ) . Segment IV was supplied either by one artery in 89.6 % of...
liver left lobe is,
for a long time,
predominant in size.
Right lobe and segment IV are small.
this segment will develop and the size of the left lobe will decrease (10). During the developmental stage of life,
the liver is supplied by 3 arteries: the middle hepatic artery (CHA) destined to the segment IV in the Michels study (11),
the LHA and the RHA which are anastomosed in the hilum.
Some of them regress while the enteric arteries expand (12). Segment IV arterial...
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