Presentation
Epigastric pain, aggravated after meals. Endoscopy - No significant finding.
Patient Data
Median arcuate ligament of the diaphragm appears thick (12 mm), producing compression & flattening of anterior surface of abdominal aorta at D12 to D12/L1 level.
Root of celiac trunk compressed by thick median arcuate ligament, accompanied by distal dilatation.
Left gastric artery arises from superior surface of celiac trunk instead of trifurcation.
Hepatic artery continues as right hepatic artery. Left hepatic artery (LHA) is rudimentary or absent.
Left hepatic lobe gets aberrant left hepatic artery from left gastric artery.
The rest of left gastric artery (distal to aberrant LHA) is hypoplastic.
Intense incomplete peripheral nodular enhancement in hepatic segment IVb, most likely representing hemangioma.
Minimal pleural effusion on both sides.
Median arcuate ligament of the diaphragm appears thick (12 mm), producing compression & flattening of anterior surface of abdominal aorta at D12 to D12/L1 level.
Root of celiac trunk compressed by thick median arcuate ligament, accompanied by distal dilatation.
Left gastric artery arises from superior surface of celiac trunk instead of trifurcation.
Hepatic artery continues as right hepatic artery. Left hepatic artery (LHA) rudimentary or absent.
Left hepatic lobe gets aberrant left hepatic artery from left gastric artery.
Rest of left gastric artery (distal to aberrant LHA) is hypoplastic.
Case Discussion
Replaced or aberrant left hepatic artery originating from the left gastric artery is a type II under Michel's classification of hepatic artery variants and is among the commonest variants of hepatic vasculature. Its clinical importance lies in the fact that since the same artery supplies two important organs, any disease, surgery or intervention involving either (stomach or liver) may jeopardise blood supply to the other.
The significant compression on the root of the celiac trunk, evidenced by luminal narrowing and distal dilatation, as well as flattening of the anterior surface of the aorta and distal hypoplasia of the left gastric artery may all explain the patient's intermittent post-prandial epigastric cramping pains as intermittent ischemic attacks.