Cardiovascular system · Abdomen
Hepatic veins !
The hepatic veins drain blood out of the liver into the inferior vena cava, just below the heart; they run between the liver segments.
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What it is
Three large veins (right, middle, left) draining the liver into the vena cava just below the diaphragm.
What it does
Return blood from the liver. They run between the liver segments and mark their borders.
Key facts
- Drains
- Liver: right (VI, VII, parts of V and VIII), middle (IV, V, VIII), left (II, III); caudate drains separately
- Into
- IVC just below the diaphragm (caval opening at T8); middle and left often join first
Relations
- Course
- Within the liver they converge upward and backward toward the bare area and empty into the inferior vena cava just below the diaphragm
- Behind
- Inferior vena cava, embedded in its groove on the back of the liver; the caudate lobe lies just to the left of the vena cava
- Above
- Diaphragm and, just above it, the right atrium, so raised right heart pressure is passed straight back into the liver
How to find it
Not palpable. In liver surgery they are reached at the top of the liver, where they enter the inferior vena cava, after the coronary and triangular ligaments are divided.
On imaging
A subcostal ultrasound view shows the three veins converging on the inferior vena cava; their walls are thin and hard to see, unlike the bright, fibrous walls of portal branches. Doppler normally shows a phasic waveform driven by the right heart, which flattens in cirrhosis and is lost in Budd–Chiari syndrome.
Clinical notes
- Budd–Chiari syndrome causes abdominal pain, a large tender liver and ascites; causes include clotting disorders and webs in the vena cava
- A catheter wedged in a hepatic vein measures the hepatic venous pressure gradient, an indirect estimate of portal pressure
- In TIPS the stent runs from a hepatic vein, most often the right, to a branch of the portal vein
- In right heart failure blood backs up into the hepatic veins, causing congestive hepatomegaly and, when tricuspid regurgitation is present, a pulsatile liver
Anatomical variants
- An inferior right hepatic vein draining segment VI straight into the inferior vena cava is frequent (texts vary on how often) and matters in right hepatectomy and living donor grafts
- The middle and left hepatic veins usually join before entering the vena cava, but may enter separately
Development
They come from the vitelline veins: the growing liver breaks these veins into sinusoids, and the channels that drain the sinusoids toward the heart become the hepatic veins, while those that carry blood in become branches of the portal vein.
Related conditions
Test yourself
Think of the answer, then tap the question to see it.
How many main hepatic veins are there, and where do they drain?
Three (right, middle, left), into the inferior vena cava just below the diaphragm; the middle and left often join first. The caudate lobe drains separately.
Which hepatic vein lies in Cantlie's line, and what does that line separate?
The middle hepatic vein; Cantlie's line is the plane between the right and left hemiliver, as hepatic veins run between segments.
What is Budd–Chiari syndrome, and why does the caudate lobe enlarge in it?
Blockage of hepatic venous outflow, with pain, a large tender liver and ascites; the caudate lobe is spared because its small veins drain straight into the vena cava.
In TIPS, between which vessels does the stent run?
From a hepatic vein, most often the right, to a branch of the portal vein.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- venae hepaticae TA2 4994
- Official Spanish (DeCS)
- Venas hepáticas DeCS D006503
- English (TA2)
- Hepatic veins
Related
Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis: Liver; Anatomy, Abdomen and Pelvis, Portal Venous System (Hepatic Portal System); Anatomy of the Human Body (20th ed.): Development of the Vascular System (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain.
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Representative model, for educational purposes only.
