Transjugular Liver Biopsy: A Case of a Phrenic Vein Mimic of the Right Hepatic Vein

Proposed by Charles Dotter[1] and expanded upon by Hanafee and Weiner,[2] transjugular liver biopsy (TJLB) is a well-established, validated, and safe alternative to percutaneous hepatic tissue sampling in patients with acute or chronic hepatic dysfunction who are at risk for hemorrhage. Here, the authors describe a case in which a right phrenic vein mimic of the right hepatic vein (RHV) resulted in nontargeted sampling of diaphragmatic skeletal muscle and a small hemothorax.

Financial Disclosures

None.

Publication History

Article published online:
18 February 2022

• References

• 1 Dotter CT. Catheter biopsy. Experimental technic for transvenous liver biopsy. Radiology 1964; 82: 312-314
• 2 Hanafee W, Weiner M. Transjugular percutaneous cholangiography. Radiology 1967; 88 (01) 35-39
• 3 Crawford AR, Lin XZ, Crawford JM. The normal adult human liver biopsy: a quantitative reference standard. Hepatology 1998; 28 (02) 323-331
• 4 Schwarzer R, Ferlitsch A. Liver biopsy-transjugular. Clin Liver Dis (Hoboken) 2014; 4 (05) 113-115
• 5 Behrens G, Ferral H, Giusto D, Patel J, Van Thiel DH. Transjugular liver biopsy: comparison of sample adequacy with the use of two automated needle systems. J Vasc Interv Radiol 2011; 22 (03) 341-345
• 6 Cholongitas E, Quaglia A, Samonakis D. et al. Transjugular liver biopsy: how good is it for accurate histological interpretation?. Gut 2006; 55 (12) 1789-1794
• 7 Procopet B, Bureau C, Métivier S. et al. Tolerance of liver biopsy in a tertiary care center: comparison of the percutaneous and the transvenous route in 143 prospectively followed patients. Eur J Gastroenterol Hepatol 2012; 24 (10) 1209-1213
• 8 Ble M, Procopet B, Miquel R, Hernandez-Gea V, García-Pagán JC. Transjugular liver biopsy. Clin Liver Dis 2014; 18 (04) 767-778
• 9 Behrens G, Ferral H. Transjugular liver biopsy. Semin Intervent Radiol 2012; 29 (02) 111-117
• 10 Navuluri R, Ahmed O. Complications of transjugular biopsies. Semin Intervent Radiol 2015; 32 (01) 42-48
• 11 Dohan A, Guerrache Y, Boudiaf M, Gavini JP, Kaci R, Soyer P. Transjugular liver biopsy: indications, technique and results. Diagn Interv Imaging 2014; 95 (01) 11-15
• 12 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions - Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
• 13 Soyer P, Bluemke DA, Choti MA, Fishman EK. Variations in the intrahepatic portions of the hepatic and portal veins: findings on helical CT scans during arterial portography. AJR Am J Roentgenol 1995; 164 (01) 103-108
• 14 Fang CH, You JH, Lau WY. et al. Anatomical variations of hepatic veins: three-dimensional computed tomography scans of 200 subjects. World J Surg 2012; 36 (01) 120-124
• 15 Cheng YF, Huang TL, Chen CL. et al. Variations of the left and middle hepatic veins: application in living related hepatic transplantation. J Clin Ultrasound 1996; 24 (01) 11-16
• 16 Sureka B, Sharma N, Khera PS, Garg PK, Yadav T. Hepatic vein variations in 500 patients: surgical and radiological significance. Br J Radiol 2019; 92 (1102): 20190487
• 17 Elsayes KM, Shaaban AM, Rothan SM. et al. A comprehensive approach to hepatic vascular disease. Radiographics 2017; 37 (03) 813-836
• 18 Loukas M, Louis Jr RG, Hullett J, Loiacano M, Skidd P, Wagner T. An anatomical classification of the variations of the inferior phrenic vein. Surg Radiol Anat 2005; 27 (06) 566-574
• 19 Loukas M, Diala Z, Tubbs RS. et al. A review of the distribution of the arterial and venous vasculature of the diaphragm and its clinical relevance. Folia Morphol (Warsz) 2008; 67 (03) 159-165
• 20 Ibukuro K, Tsukiyama T, Mori K, Inoue Y. Precaval draining vein from paraesophageal varices: radiologic-anatomic correlation. AJR Am J Roentgenol 1999; 172 (03) 651-654
• 21 Sharma M, Rameshbabu CS. Collateral pathways in portal hypertension. J Clin Exp Hepatol 2012; 2 (04) 338-352
• 22 Kiyosue H, Ibukuro K, Maruno M, Tanoue S, Hongo N, Mori H. Multidetector CT anatomy of drainage routes of gastric varices: a pictorial review. Radiographics 2013; 33 (01) 87-100
• 23 Torzilli G, Montorsi M, Palmisano A. et al. Right inferior phrenic vein indicating the right hepatic vein confluence into the inferior vena cava. Am J Surg 2006; 192 (05) 690-694
• 24 Oliver KA, Ashurst JV. Anatomy, Thorax, Phrenic Nerves. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. PMID:30020697
• 25 Bull HJ, Gilmore IT, Bradley RD, Marigold JH, Thompson RP. Experience with transjugular liver biopsy. Gut 1983; 24 (11) 1057-1060