Portography in decision-making about indications for liver resection in hepatolithiasis

We studied the findings of portograms of patients with hepatolithiasis and the role of portography in decision-making about indications for hepatic resection. The subjects were 20 patients in whom hepatic arteriography including the portal phase or percutaneous transhepatic portography was done. We studied the relationships between the findings of the portograms and cholangiograms and hepatic atrophy or associated cholangiocarcinoma. The portal vein in the involved segment of the liver was obstructed in nine patients, and these patients had hepatic atrophy with or without cholangiocarcinoma. There were 16 patients with hepatic atrophy. Four of five other patients in whom protal shrinking was seen had hepatic atrophy. Bile ducts in the involved segment were obstructed in six patients with hepatic atrophy. In all five patients with cholangiocarcinoma, there was portal obstruction at the branching point in the hepatic hilum, with obstruction of the bile ducts at the same point in two of these patients. Hepatic atrophy and cholangiocarcinoma was more closely associated to changes of the portal vein than obstruction of the bile ducts. Portography is useful to diagnose hepatic atrophy and cholangiocarcinoma and for decision-making about indications for hepatic resection in hepatolithiasis.