What is the anatomical relationship of the common bile duct (CBD) to the hepatic artery (HA)?

Anatomical Relationship of the Common Bile Duct

The common bile duct lies to the right of the hepatic artery (option e is correct).

Normal Anatomy of the Porta Hepatis

The porta hepatis contains three main structures arranged in a specific anatomical relationship:

1. Portal Vein: Located most posteriorly in the porta hepatis 1
2. Hepatic Artery: Located anterior to the portal vein 1
3. Common Bile Duct: Located anterior to the portal vein and lateral (to the right) of the hepatic artery 1, 2

This anatomical arrangement is clinically significant and follows a consistent pattern that can be identified during imaging and surgical procedures.

Detailed Anatomical Relationships

• The common bile duct and hepatic artery typically lie anterior to the portal vein 1
• The common bile duct is usually positioned more laterally (to the right) than the hepatic artery 1
• In ultrasound imaging, this relationship helps distinguish the common bile duct from the hepatic artery, as the bile duct lacks the color-flow Doppler signal seen in the artery 1
• The common hepatic and proximal common bile ducts lie anteriorly and generally to the right of the portal vein in the porta hepatis 2

Clinical Significance

Understanding this anatomical relationship is critical for:

• Surgical Procedures: Particularly during cholecystectomy and other hepatobiliary surgeries 3
• Prevention of Bile Duct Injuries: Knowledge of normal anatomy helps avoid iatrogenic injuries during surgery 3
• Diagnostic Imaging: Proper identification of these structures on ultrasound and other imaging modalities 3

Anatomical Variations

While the described relationship is the most common arrangement, variations can occur:

• The right hepatic artery may rarely travel anteriorly to the common bile duct instead of its usual position 4
• Intrahepatic bile ducts may have variable relationships to portal veins, being anterior in some segments and posterior in others 5
• The branching pattern of the right hepatic duct can be atypical in approximately 34% of cases 6

Surgical Implications

• During cholecystectomy, identification of the critical view of safety (CVS) as described by Strasberg is essential to prevent bile duct injuries 3
• When performing biliary procedures, surgeons must be aware of the normal anatomical relationships to avoid misidentification of structures 3
• In cases of difficult dissection, adjuncts such as intraoperative cholangiography may help confirm the anatomy 3

Understanding this anatomical relationship is fundamental for safe hepatobiliary surgery and accurate interpretation of diagnostic imaging.