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Accessory Left Gastric Artery from Left Hepatic Artery Shown on MDCT and Conventional Angiography: Correlation with CT Hepatic Arteriography

Kousei Ishigami1, Kengo Yoshimitsu1, Hiroyuki Irie1, Tsuyoshi Tajima1, Yoshiki Asayama1, Masakazu Hirakawa1 and Hiroshi Honda1

1 All authors: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan.


Figure 1
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  		Fig. 1A —77-year-old man with proximal-type accessory left gastric artery. Hepatic arterial phase image of contrast-enhanced MDCT shows vessel running through fissure of ligamentum venosum (white arrow). Note tortuosity of vessel near cardia of stomach. Black arrow indicates origin of accessory left gastric artery.

 

Figure 2
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  		Fig. 1B —77-year-old man with proximal-type accessory left gastric artery. Digital subtraction angiography image from left hepatic artery shows accessory left gastric artery, origin of which is midportion of left hepatic artery (large arrow). Gastric wall stain (arrowhead) is seen. Esophageal branch from accessory left gastric artery (small arrow) is noted.

 

Figure 3
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  		Fig. 1C —77-year-old man with proximal-type accessory left gastric artery. CT hepatic arteriography image from left hepatic artery shows intensely enhancing vessel in fissure of ligamentum venosum (white arrow) with contrast enhancement of cardia and fundus of stomach (black arrow), consistent with an accessory left gastric artery.

 

Figure 4
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  		Fig. 2A —71-year-old man (patient 10 in Table 2) with distal-type accessory left gastric artery that was not recognized on conventional angiography. Digital subtraction angiography image from proper hepatic artery shows accessory left gastric artery arising near umbilical point (black arrow). In retrospect, gastric wall stain (white arrow) is noted overlying lateral edge of liver. Arrowhead indicates right gastric artery.

 

Figure 5
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  		Fig. 2B —71-year-old man (patient 10 in Table 2) with distal-type accessory left gastric artery that was not recognized on conventional angiography. Vessel within ligamentum venosum (arrow) is seen on hepatic arterial phase image of contrast-enhanced MDCT. This vessel is continuous to left hepatic artery (not shown), suggestive of accessory left gastric artery. Asterisk indicates splenic infarction after partial splenic embolization that occurred previously.

 

Figure 6
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  		Fig. 2C —71-year-old man (patient 10 in Table 2) with distal-type accessory left gastric artery that was not recognized on conventional angiography. CT hepatic arteriography images from proper hepatic artery clearly reveal contrast enhancement of cardia of stomach (arrow, C) and accessory left gastric artery (arrow, D).

 

Figure 7
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  		Fig. 2D —71-year-old man (patient 10 in Table 2) with distal-type accessory left gastric artery that was not recognized on conventional angiography. CT hepatic arteriography images from proper hepatic artery clearly reveal contrast enhancement of cardia of stomach (arrow, C) and accessory left gastric artery (arrow, D).

 

Figure 8
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  		Fig. 3A —67-year-old man with diaphragmatic branch from accessory left gastric artery. Digital subtraction angiography image from proper hepatic artery shows accessory left gastric artery and esophageal branch (small arrows). Diaphragmatic branch from origin of accessory left gastric artery (large arrows) is noted. However, it was thought to be intrahepatic arterial branch. Vasospasm of proper hepatic artery is seen.

 

Figure 9
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  		Fig. 3B —67-year-old man with diaphragmatic branch from accessory left gastric artery. CT hepatic arteriography image reveals arterial branch toward diaphragm (black arrow). Contrast enhancement of esophageal wall (white arrow) is also noted.

 

Figure 10
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  		Fig. 4A —Schematic drawing of two types of accessory left gastric artery: proximal (A) and distal (B) types. ALGA = accessory left gastric artery, PHA = proper hepatic artery, RHA = right hepatic artery, LHA = left hepatic artery, A2 = dorsolateral branch, A3 = ventrolateral branch, A4 = medial segmental branch, UP = umbilical point. For proximal type, origin of accessory left gastric artery (arrow) is between origin and proximal two thirds of left hepatic artery.

 

Figure 11
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  		Fig. 4B —Schematic drawing of two types of accessory left gastric artery: proximal (A) and distal (B) types. ALGA = accessory left gastric artery, PHA = proper hepatic artery, RHA = right hepatic artery, LHA = left hepatic artery, A2 = dorsolateral branch, A3 = ventrolateral branch, A4 = medial segmental branch, UP = umbilical point. For distal type, origin of accessory left gastric artery (arrow) is near umbilical point.

 

Figure 12
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  		Fig. 5A —70-year-old man with right gastric artery arising from left hepatic artery, which was thought to be accessory left gastric artery. Digital subtraction angiography image from common hepatic artery shows artery arising from proximal left hepatic artery (arrow), mimicking accessory left gastric artery. Tumor stain in lateral segment of left hepatic lobe (arrowhead) is also noted, representing hepatocellular carcinoma.

 

Figure 13
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  		Fig. 5B —70-year-old man with right gastric artery arising from left hepatic artery, which was thought to be accessory left gastric artery. CT hepatic arteriography from proper hepatic artery shows contrast enhancement of lesser curvature of distal stomach (white arrow) corresponding to vascular territory of right gastric artery (black arrow).

 

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