Diaphragmatic sulci and portal fissures

Diaphragmatic sulci in the superior surface of the liver were found in 40% of cases at autopsy. All sulci were located in the right lobe and in 47% they were multiple. In order to evaluate possible predisposing factors for these accessory sulci, their topography and characteristics were observed in unfixed livers; moreover, intravenous injections of radio-opaque resins were performed in the portal and hepatic veins (HVs). After formalin fixation, the livers underwent CT and MR scans and a three-dimensional (3D) elaboration of the images was performed. Radiological examination revealed a correspondence between the topography of the sulci and the course of the right and middle HVs and their main tributaries in 67%. The corrosion casts showed the location of the sulci at the level of the boundaries between the ramifications of the terminal branches of the portal triad, where the HVs are located, in 73%. These findings suggest that, rather than the action of 'special' or hypertrophied muscle bundles, the pressure exerted by the diaphragm as a whole may be responsible for the production of sulci at the level of weak zones, represented by the portal fissures, where the watershed superficial hepatic parenchyma, owing to the absence of all but the smallest vascular branches, exhibits a lower resistance to external pressure.