Replaced left and right hepatic arteries
Incidental anatomy noted on workup of enhancing liver lesions.
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CT in late arterial phase of contrast enhancement shows arterial anatomy in this patient with both replaced left and right hepatic arteries.
The left hepatic artery (red arrow) can be seen coursing through the fissure for ligamentum venosum and originating from the left gastric artery. The left gastric artery itself has a tortuous course and originates from the superior aspect of the celiac trunk.
The right hepatic artery (green arrow) is centered in the hepatic hilum, and courses posterior to the main portal vein, originating from the superior mesenteric artery.
As the hepatic arteries are both replaced, there is no common hepatic artery, and instead the gastroduodenal artery (blue arrow) arises directly from the celiac artery.
This case nicely demonstrates two common variants which typically occur independently of each other.
Such variants are especially important to report when trans-arterial therapy of hepatic lesions, or surgery, is being considered.