Q:

Intraoperative ultrasound is now commonly used by the hepatic surgeon. Which of the following statement(s) is/are true concerning intraoperative ultrasound and hepatic surgery?

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Intraoperative ultrasound is now commonly used by the hepatic surgeon. Which of the following statement(s) is/are true concerning intraoperative ultrasound and hepatic surgery?


  1. An intraoperative ultrasound offers no advantage to conventional transcorporial ultrasound in detection of hepatic lesions
  2. Portal structures can be differentiated from hepatic veins by the extension of Glisson’s capsule surrounding these structures
  3. It is difficult on ultrasound to differentiate a vascular structure from a mass
  4. The short hepatic veins are difficult to detect with intraoperative ultrasound

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b. Portal structures can be differentiated from hepatic veins by the extension of Glisson’s capsule surrounding these structures

Over the past 10 years, detailed anatomic description of the hepatic veins, portal pedicles, and the inferior vena cava have been possible through the use of intraoperative ultrasound. Cooperation between radiologists and hepatic surgeon with the use of intraoperative ultrasound has allowed the identification of lesions during surgery that were not visible by conventional transcorporial ultrasound or CT scanning. Beginning superiorly at the inferior vena cava, the confluence and course of each of the hepatic veins can easily be determined. More inferiorly, the main right and left portal pedicles can be seen coursing transversely in the transverse scissura. Portal structures can easily be differentiated from hepatic veins by the hyperechoic extensions of Glisson’s capsule which surround these structures. When a circular structure is encountered, a mass or metastasis may be suspected. Scanning away from the mass may reveal a tubulovascular shape which has been imaged and cross sectioned. Flattening of the circular mass by external compression with the ultrasound probe will also differentiate a vascular structure from a solid mass.

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