0:01

So this patient is a young patient, around 35 years old,

0:03

female, and is being evaluated as a

0:06

liver donor, and so we're being asked to look

0:08

at her anatomy prior to potential surgical

0:11

resection, and this is a little bit of an older

0:14

case, and normally we do CT imaging to look at

0:17

some of the vascular anatomy, and we do the MR

0:19

imaging to look at some of the biliary anatomy.

0:22

And there are different institutions that,

0:23

you know, utilize CT and MR differently.

0:25

However, let's say about a decade ago, we would

0:28

use CT imaging to evaluate everything because

0:31

we had a contrast agent called cholangiogram

0:33

that would be excreted through the bile ducts.

0:36

Um, and would nicely

0:37

delineate the biliary anatomy.

0:39

However, that contrast agent is

0:40

actually no longer on the market.

0:41

So we don't see these types of studies anymore.

0:44

Nevertheless, I thought this was a nice case

0:47

in order to show another anatomic variation

0:50

that we can see in the biliary anatomy.

0:52

So as we scroll down over here, we can see

0:54

that the contrast agent is being excreted in

0:56

the bile ducts; therefore, they look brighter

0:58

than they would normally be expected to look.

1:01

We can see the left hepatic

1:02

duct coming over here.

1:04

We can see the anterior branch of the

1:06

right hepatic duct here, and the posterior

1:08

branch of the right hepatic duct over here.

1:11

I'm going to magnify as we scroll downwards.

1:14

All three of them are coming together,

1:16

coming together, coming together.

1:18

And right around here, you can see that

1:20

the left, the anterior right, and the

1:24

posterior right meet right at the same spot.

1:29

Okay.

1:30

They meet right there and continue

1:32

downwards as the common hepatic duct.

1:34

I'll show it to you on the coronals as well.

1:37

You can see the left hepatic duct coming

1:38

downwards here, the right anterior

1:41

hepatic duct coming over here, and

1:44

the posterior duct coming over here.

1:46

So let's follow this and this.

1:49

They're going to come together.

1:51

And that left hepatic duct also

1:53

comes right at the same spot.

1:54

Okay.

1:55

And we'll make that maybe a little bit

1:57

thicker so that we can, uh, appreciate

2:00

some of this anatomy right around here.

2:03

So this is the left one, this is the

2:05

anterior right, this is the posterior

2:07

right, all coming to a single spot.

2:10

And so this specific variation is known

2:13

as a trifurcation, where all three of them

2:15

come together and meet at the same spot.

2:18

It's also one that is relatively

2:19

common, estimated to occur in

2:21

about 11% of patients.

2:24

It has no real clinical significance

2:27

other than knowledge of this anatomic

2:29

variation is important for surgeons to

2:31

know prior to any surgery that involves,

2:34

you know, resection of the liver or

2:36

resection of some of the biliary tree.