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Intermediate hepatic vein

The intermediate hepatic vein (IHV), also commonly referred to as the middle hepatic vein, is one of the three major hepatic veins (right, intermediate, left) that drain blood from the liver into the inferior vena cava (IVC) just below the diaphragm.

The IHV courses within the main plane of the liver, lying between the right and left functional lobes, and serves as an important anatomical landmark for liver segmentation. It primarily drains the medial segment of the left lobe (segment IV) and the anterior segment of the right lobe (segments V and VIII).

It runs superiorly within the main portal fissure, passing between the right and left lobes, and empties into the IVC close to the junction of the left and right hepatic veins. Due to its location, it is a critical reference structure in liver surgery, transplantation, and segmental resections, and it is frequently assessed in hepatic vein obstruction and Budd–Chiari syndrome.

Synonyms

  • Middle hepatic vein

  • Central hepatic vein

  • Vena hepatica media

Function

  • Drains venous blood from segments IV, V, and VIII of the liver

  • Converges with the right and left hepatic veins to empty into the IVC

  • Serves as a surgical landmark for dividing right and left functional lobes

  • Important in hepatic outflow, transplantation, and resection planning

Tributaries

  • Segment IV veins (left medial segment)

  • Segment V veins (right anterior inferior)

  • Segment VIII veins (right anterior superior)

MRI Appearance

T1-weighted images:

  • IHV appears as a signal void (black lumen) due to venous flow

  • Surrounded by hypointense vessel wall and high-signal hepatic parenchyma

T2-weighted images:

  • Vessel lumen appears as a dark flow void

  • Thrombosis or Budd–Chiari syndrome shows intermediate to hyperintense signal within the lumen

STIR:

  • Suppresses surrounding fat, improving contrast for hepatic veins

  • Useful in detecting perivascular edema or inflammatory changes

T1 Post-Gadolinium (Gd-enhanced MRI):

  • Enhances homogeneously and brightly with hepatic venous opacification

  • Filling defects correspond to thrombus, tumor invasion, or stenosis

  • Essential for mapping venous drainage pre-surgery or transplant

MRA (Magnetic Resonance Angiography):

  • Provides 3D visualization of the hepatic venous confluence and IVC entry

  • Useful in evaluating outflow obstruction, congenital anomalies, or vascular invasion by tumors

CT Appearance

Non-contrast CT:

  • Vessel appears as a tubular low-density structure within liver parenchyma

  • Difficult to trace without contrast unless thrombosed or dilated

CT Post-Contrast (CT Venography):

  • Enhances brightly, showing the origin from segmental tributaries, superior course, and drainage into IVC

  • Multiplanar and 3D reconstructions delineate relationships with right and left hepatic veins

  • Identifies thrombosis, compression, stenosis, tumor extension, or Budd–Chiari syndrome

  • Crucial for hepatic surgical planning, transplant assessment, and oncologic staging

MRI images

Intermediate hepatic vein anatomy MRI axial image -img-00000-00000_00002

MRI images

Intermediate hepatic vein anatomy MRI coronal image -img-00000-00000

CT image

Intermediate hepatic vein ct axial