DOI: 10.1148/rg.273065036
Inferior Phrenic Artery: Anatomy, Variations, Pathologic Conditions, and Interventional Management1
Dong Il Gwon, MD,
Gi-Young Ko, MD,
Hyun-Ki Yoon, MD,
Kyu-Bo Sung, MD,
Jae Moung Lee, MD,
Seok Jong Ryu, MD,
Myong Hee Seo, MD,
Jae-Chan Shim, MD,
Ghi Jai Lee, MD, and
Ho Kyun Kim, MD
1 From the Department of Radiology, Seoul Paik Hospital, University of Inje College of Medicine, Seoul, Korea (D.I.G., J.M.L., S.J.R., M.H.S., J.C.S., G.J.L., H.K.K.); and the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea (G.Y.K., H.K.Y., K.B.S.). Recipient of a Cum Laude award for an education exhibit at the 2005 RSNA Annual Meeting. Received March 22, 2006; revision requested June 12; final revision received January 18, 2007; accepted January 26. All authors have no financial relationships to disclose.
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Figure 1a. Normal anatomy of a right IPA originating from the aorta in a 55-year-old man with a recurrent HCC in the right posterior superior hepatic lobe. (a) Arterial phase dynamic CT scan obtained after two sessions of TACE shows the right IPA (arrow) originating from the aorta. A recurrent HCC was seen in liver segment 7. (b) Selective right inferior phrenic angiogram obtained for treatment of the recurrent HCC by means of a 5-F Rösch hepatic catheter shows the normal anatomy of the right IPA, which originates from the aorta, as well as no definitive tumor staining. There was no tumor staining on a hepatic angiogram, and the viable portion of the HCC was supplied by the right 10th and 11th intercostal arteries. 1 = ascending (anterior) branch, 2 = descending (posterior) branch, 3 = inferior vena caval branch, 4 = superior adrenal branch, 5 = diaphragmatic branch.
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Figure 1b. Normal anatomy of a right IPA originating from the aorta in a 55-year-old man with a recurrent HCC in the right posterior superior hepatic lobe. (a) Arterial phase dynamic CT scan obtained after two sessions of TACE shows the right IPA (arrow) originating from the aorta. A recurrent HCC was seen in liver segment 7. (b) Selective right inferior phrenic angiogram obtained for treatment of the recurrent HCC by means of a 5-F Rösch hepatic catheter shows the normal anatomy of the right IPA, which originates from the aorta, as well as no definitive tumor staining. There was no tumor staining on a hepatic angiogram, and the viable portion of the HCC was supplied by the right 10th and 11th intercostal arteries. 1 = ascending (anterior) branch, 2 = descending (posterior) branch, 3 = inferior vena caval branch, 4 = superior adrenal branch, 5 = diaphragmatic branch.
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Figure 2a. Aortic origin of the replaced right hepatic artery and IPA as a common trunk in a 45-year-old man with an HCC in the right anterior hepatic lobe. (a) Arterial phase dynamic CT scan shows the common trunk (arrow) of the replaced right hepatic artery and IPAs originating from the aorta. At celiac angiography, the right hepatic artery was not seen and there was no definitive tumor staining. (b) Selective right hepatic arteriogram from the first session of TACE shows the common trunk (arrow) of the replaced right hepatic artery and IPAs. Note the tumor staining (*) from the replaced right hepatic artery. TACE of the tumor was successfully performed by superselectively inserting a 3-F microcatheter into the tumor feeding branches of the right anterior superior hepatic artery. 1 = anterior trunk of ascending branch, 2 = posterior trunk of ascending branch, 3 = gastric branch.
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Figure 2b. Aortic origin of the replaced right hepatic artery and IPA as a common trunk in a 45-year-old man with an HCC in the right anterior hepatic lobe. (a) Arterial phase dynamic CT scan shows the common trunk (arrow) of the replaced right hepatic artery and IPAs originating from the aorta. At celiac angiography, the right hepatic artery was not seen and there was no definitive tumor staining. (b) Selective right hepatic arteriogram from the first session of TACE shows the common trunk (arrow) of the replaced right hepatic artery and IPAs. Note the tumor staining (*) from the replaced right hepatic artery. TACE of the tumor was successfully performed by superselectively inserting a 3-F microcatheter into the tumor feeding branches of the right anterior superior hepatic artery. 1 = anterior trunk of ascending branch, 2 = posterior trunk of ascending branch, 3 = gastric branch.
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Figure 3a. HCC supplied by the right IPA in a 44-year-old man. (a) Arterial phase dynamic CT scan shows a huge mass (*) at the dome of the right hepatic lobe. (b) Selective common hepatic angiogram from the first session of TACE shows extensive hypervascular tumor staining. Note the wedge-shaped area without tumor staining (arrowhead) at the dome of the right hepatic lobe. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the celiac trunk, shows hypervascular tumor staining (arrowhead) that corresponds to the nonstained area on the common hepatic angiogram (b). (d) Radiograph obtained after embolization of the right hepatic artery and right IPA shows the HCC (*) compactly laden with Lipiodol (iodized oil; Guerbet, Roissy, France).
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Figure 3b. HCC supplied by the right IPA in a 44-year-old man. (a) Arterial phase dynamic CT scan shows a huge mass (*) at the dome of the right hepatic lobe. (b) Selective common hepatic angiogram from the first session of TACE shows extensive hypervascular tumor staining. Note the wedge-shaped area without tumor staining (arrowhead) at the dome of the right hepatic lobe. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the celiac trunk, shows hypervascular tumor staining (arrowhead) that corresponds to the nonstained area on the common hepatic angiogram (b). (d) Radiograph obtained after embolization of the right hepatic artery and right IPA shows the HCC (*) compactly laden with Lipiodol (iodized oil; Guerbet, Roissy, France).
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Figure 3c. HCC supplied by the right IPA in a 44-year-old man. (a) Arterial phase dynamic CT scan shows a huge mass (*) at the dome of the right hepatic lobe. (b) Selective common hepatic angiogram from the first session of TACE shows extensive hypervascular tumor staining. Note the wedge-shaped area without tumor staining (arrowhead) at the dome of the right hepatic lobe. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the celiac trunk, shows hypervascular tumor staining (arrowhead) that corresponds to the nonstained area on the common hepatic angiogram (b). (d) Radiograph obtained after embolization of the right hepatic artery and right IPA shows the HCC (*) compactly laden with Lipiodol (iodized oil; Guerbet, Roissy, France).
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Figure 3d. HCC supplied by the right IPA in a 44-year-old man. (a) Arterial phase dynamic CT scan shows a huge mass (*) at the dome of the right hepatic lobe. (b) Selective common hepatic angiogram from the first session of TACE shows extensive hypervascular tumor staining. Note the wedge-shaped area without tumor staining (arrowhead) at the dome of the right hepatic lobe. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the celiac trunk, shows hypervascular tumor staining (arrowhead) that corresponds to the nonstained area on the common hepatic angiogram (b). (d) Radiograph obtained after embolization of the right hepatic artery and right IPA shows the HCC (*) compactly laden with Lipiodol (iodized oil; Guerbet, Roissy, France).
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Figure 4a. HCC exclusively supplied by the right IPA in a 58-year-old man. (a) Arterial phase dynamic CT scan shows a hypervascular mass (*) in the posterior portion of the right hepatic lobe. Note the hypertrophied ascending portion of the right IPA (arrow). (b) Selective celiac angiogram from the first session of TACE shows no definitive tumor staining. We concluded that the feeding vessel might be the right IPA because of the tumor location directly adjacent to the posterior diaphragm, the hypertrophied right IPA, and the absence of tumor staining at celiac angiography. Dynamic CT showed that the right IPA originated from the right renal artery; therefore, aortography for detection of the right IPA was not performed. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the right renal artery, shows hypervascular tumor staining (*). The intercostal artery (arrowhead) arising from the right IPA is the feeding vessel for the HCC. (d) Radiograph obtained after embolization of the right IPA shows the compact HCC (*) laden with iodized oil.
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Figure 4b. HCC exclusively supplied by the right IPA in a 58-year-old man. (a) Arterial phase dynamic CT scan shows a hypervascular mass (*) in the posterior portion of the right hepatic lobe. Note the hypertrophied ascending portion of the right IPA (arrow). (b) Selective celiac angiogram from the first session of TACE shows no definitive tumor staining. We concluded that the feeding vessel might be the right IPA because of the tumor location directly adjacent to the posterior diaphragm, the hypertrophied right IPA, and the absence of tumor staining at celiac angiography. Dynamic CT showed that the right IPA originated from the right renal artery; therefore, aortography for detection of the right IPA was not performed. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the right renal artery, shows hypervascular tumor staining (*). The intercostal artery (arrowhead) arising from the right IPA is the feeding vessel for the HCC. (d) Radiograph obtained after embolization of the right IPA shows the compact HCC (*) laden with iodized oil.
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Figure 4c. HCC exclusively supplied by the right IPA in a 58-year-old man. (a) Arterial phase dynamic CT scan shows a hypervascular mass (*) in the posterior portion of the right hepatic lobe. Note the hypertrophied ascending portion of the right IPA (arrow). (b) Selective celiac angiogram from the first session of TACE shows no definitive tumor staining. We concluded that the feeding vessel might be the right IPA because of the tumor location directly adjacent to the posterior diaphragm, the hypertrophied right IPA, and the absence of tumor staining at celiac angiography. Dynamic CT showed that the right IPA originated from the right renal artery; therefore, aortography for detection of the right IPA was not performed. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the right renal artery, shows hypervascular tumor staining (*). The intercostal artery (arrowhead) arising from the right IPA is the feeding vessel for the HCC. (d) Radiograph obtained after embolization of the right IPA shows the compact HCC (*) laden with iodized oil.
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Figure 4d. HCC exclusively supplied by the right IPA in a 58-year-old man. (a) Arterial phase dynamic CT scan shows a hypervascular mass (*) in the posterior portion of the right hepatic lobe. Note the hypertrophied ascending portion of the right IPA (arrow). (b) Selective celiac angiogram from the first session of TACE shows no definitive tumor staining. We concluded that the feeding vessel might be the right IPA because of the tumor location directly adjacent to the posterior diaphragm, the hypertrophied right IPA, and the absence of tumor staining at celiac angiography. Dynamic CT showed that the right IPA originated from the right renal artery; therefore, aortography for detection of the right IPA was not performed. (c) Selective angiogram obtained via the right IPA (arrow), which originates from the right renal artery, shows hypervascular tumor staining (*). The intercostal artery (arrowhead) arising from the right IPA is the feeding vessel for the HCC. (d) Radiograph obtained after embolization of the right IPA shows the compact HCC (*) laden with iodized oil.
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Figure 5a. Right IPA originating from the left gastric artery in a 47-year-old woman. (a) Arterial phase dynamic CT scan shows the right IPA (arrow) originating from the left gastrohepatic trunk (arrowhead). (b) Selective angiogram obtained via the gastrohepatic trunk (arrowhead) shows the right IPA (black arrow) and the replaced left hepatic artery (white arrow). Note the tumor staining (*) from the replaced left hepatic artery.
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Figure 5b. Right IPA originating from the left gastric artery in a 47-year-old woman. (a) Arterial phase dynamic CT scan shows the right IPA (arrow) originating from the left gastrohepatic trunk (arrowhead). (b) Selective angiogram obtained via the gastrohepatic trunk (arrowhead) shows the right IPA (black arrow) and the replaced left hepatic artery (white arrow). Note the tumor staining (*) from the replaced left hepatic artery.
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Figure 6a. Left IPA originating from the proper hepatic artery in a 42-year-old woman with a dysplastic nodule in the right anterior inferior hepatic lobe. (a) Selective common hepatic angiogram shows the left IPA (arrow) originating from the proper hepatic artery and no definitive tumor staining. Note the accessory left gastric artery (arrowhead) arising from the left IPA and the gastric staining (*). 1 = anterior trunk of ascending branch of the left IPA, 2 = posterior trunk of ascending branch of the left IPA. (b) CTHA image obtained for evaluation of the dysplastic nodule shows the left IPA (arrow) and accessory left gastric artery (arrowhead). Note the gastric staining (*).
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Figure 6b. Left IPA originating from the proper hepatic artery in a 42-year-old woman with a dysplastic nodule in the right anterior inferior hepatic lobe. (a) Selective common hepatic angiogram shows the left IPA (arrow) originating from the proper hepatic artery and no definitive tumor staining. Note the accessory left gastric artery (arrowhead) arising from the left IPA and the gastric staining (*). 1 = anterior trunk of ascending branch of the left IPA, 2 = posterior trunk of ascending branch of the left IPA. (b) CTHA image obtained for evaluation of the dysplastic nodule shows the left IPA (arrow) and accessory left gastric artery (arrowhead). Note the gastric staining (*).
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Figure 7a. Right IPA originating from the superior mesenteric artery and supplying a huge HCC in a 49-year-old woman. (a) Arterial phase dynamic CT scan shows the right IPA (arrow) originating from the superior mesenteric artery (arrowhead). (b) Arterial phase dynamic CT scan obtained at a higher level shows a huge HCC (*) at the dome of the right hepatic lobe. Note the hypertrophied right IPA (arrow). (c) Selective superior mesenteric angiogram from the first session of TACE shows hypervascular tumor staining (*) from the right IPA (arrow), which originates from the superior mesenteric artery (arrowhead). Celiac angiography showed the huge hypervascular tumor with faint tumor staining, which corresponded to the hypervascular tumor staining seen on the superior mesenteric angiogram, in the right superior portion of the liver.
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Figure 7b. Right IPA originating from the superior mesenteric artery and supplying a huge HCC in a 49-year-old woman. (a) Arterial phase dynamic CT scan shows the right IPA (arrow) originating from the superior mesenteric artery (arrowhead). (b) Arterial phase dynamic CT scan obtained at a higher level shows a huge HCC (*) at the dome of the right hepatic lobe. Note the hypertrophied right IPA (arrow). (c) Selective superior mesenteric angiogram from the first session of TACE shows hypervascular tumor staining (*) from the right IPA (arrow), which originates from the superior mesenteric artery (arrowhead). Celiac angiography showed the huge hypervascular tumor with faint tumor staining, which corresponded to the hypervascular tumor staining seen on the superior mesenteric angiogram, in the right superior portion of the liver.
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Figure 7c. Right IPA originating from the superior mesenteric artery and supplying a huge HCC in a 49-year-old woman. (a) Arterial phase dynamic CT scan shows the right IPA (arrow) originating from the superior mesenteric artery (arrowhead). (b) Arterial phase dynamic CT scan obtained at a higher level shows a huge HCC (*) at the dome of the right hepatic lobe. Note the hypertrophied right IPA (arrow). (c) Selective superior mesenteric angiogram from the first session of TACE shows hypervascular tumor staining (*) from the right IPA (arrow), which originates from the superior mesenteric artery (arrowhead). Celiac angiography showed the huge hypervascular tumor with faint tumor staining, which corresponded to the hypervascular tumor staining seen on the superior mesenteric angiogram, in the right superior portion of the liver.
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Figure 8a. Left IPA originating from the right IPA in a 49-year-old woman who had undergone S6 segmentectomy. (a) Arterial phase dynamic CT scan obtained after the second session of postoperative TACE shows a recurrent tumor (*) at the resection margin. Note the right IPA (arrow), which originates from the celiac axis. (b) Selective angiogram obtained via the right IPA (black arrow) shows the left IPA (arrowhead) originating from the right IPA. Note the esophageal branch (white arrow) of the left IPA and the tumor staining (*).
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Figure 8b. Left IPA originating from the right IPA in a 49-year-old woman who had undergone S6 segmentectomy. (a) Arterial phase dynamic CT scan obtained after the second session of postoperative TACE shows a recurrent tumor (*) at the resection margin. Note the right IPA (arrow), which originates from the celiac axis. (b) Selective angiogram obtained via the right IPA (black arrow) shows the left IPA (arrowhead) originating from the right IPA. Note the esophageal branch (white arrow) of the left IPA and the tumor staining (*).
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Figure 9a. Hemoptysis due to right middle lobe collapse with bronchiectasis in a 66-year-old woman. (a) Contrast-enhanced chest CT scan obtained at the level of the celiac trunk shows the right IPA (arrows) originating from the aorta. (b) Contrast-enhanced chest CT scan obtained at a higher level shows collapse of the right middle lobe (*). Note the hypertrophied vascular structure (arrow) near the right atrium. (c) Selective right inferior phrenic angiogram shows pulmonary arterial shunts (arrowheads) supplied by the hypertrophied pericardiophrenic artery (white arrow), which originates from the right IPA (black arrow).
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Figure 9b. Hemoptysis due to right middle lobe collapse with bronchiectasis in a 66-year-old woman. (a) Contrast-enhanced chest CT scan obtained at the level of the celiac trunk shows the right IPA (arrows) originating from the aorta. (b) Contrast-enhanced chest CT scan obtained at a higher level shows collapse of the right middle lobe (*). Note the hypertrophied vascular structure (arrow) near the right atrium. (c) Selective right inferior phrenic angiogram shows pulmonary arterial shunts (arrowheads) supplied by the hypertrophied pericardiophrenic artery (white arrow), which originates from the right IPA (black arrow).
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Figure 9c. Hemoptysis due to right middle lobe collapse with bronchiectasis in a 66-year-old woman. (a) Contrast-enhanced chest CT scan obtained at the level of the celiac trunk shows the right IPA (arrows) originating from the aorta. (b) Contrast-enhanced chest CT scan obtained at a higher level shows collapse of the right middle lobe (*). Note the hypertrophied vascular structure (arrow) near the right atrium. (c) Selective right inferior phrenic angiogram shows pulmonary arterial shunts (arrowheads) supplied by the hypertrophied pericardiophrenic artery (white arrow), which originates from the right IPA (black arrow).
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Figure 10a. HCCs supplied by the right hepatic artery, right IPA, and reconstituted right posterior hepatic artery through the right IPA in a 63-year-old woman who had undergone six sessions of TACE. (a) Selective celiac angiogram from the seventh session of TACE shows severe injury to the proper hepatic artery and intra-hepatic arteries (arrowheads) due to previous TACE. Note the tumor staining (*) in the right hepatic lobe. (b) Selective right inferior phrenic angiogram shows that the right posterior hepatic artery (arrow) is reconstituted through the right IPA. Note the HCCs (*) supplied by the right IPA and reconstituted right posterior hepatic artery.
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Figure 10b. HCCs supplied by the right hepatic artery, right IPA, and reconstituted right posterior hepatic artery through the right IPA in a 63-year-old woman who had undergone six sessions of TACE. (a) Selective celiac angiogram from the seventh session of TACE shows severe injury to the proper hepatic artery and intra-hepatic arteries (arrowheads) due to previous TACE. Note the tumor staining (*) in the right hepatic lobe. (b) Selective right inferior phrenic angiogram shows that the right posterior hepatic artery (arrow) is reconstituted through the right IPA. Note the HCCs (*) supplied by the right IPA and reconstituted right posterior hepatic artery.
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Figure 11a. IPA reconstituted through the right middle adrenal artery in a 47-year-old man with celiac artery occlusion. (a) Arterial phase dynamic CT scan shows a hypertrophied median arcuate ligament of the right diaphragmatic crus (arrowhead) and resultant occlusion of the celiac artery (arrow). (b) Selective angiogram obtained via the right middle adrenal artery (white arrow) shows the reconstituted IPA (black arrow), which is supplied by middle-superior adrenal collateral vessels (arrowheads).
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Figure 11b. IPA reconstituted through the right middle adrenal artery in a 47-year-old man with celiac artery occlusion. (a) Arterial phase dynamic CT scan shows a hypertrophied median arcuate ligament of the right diaphragmatic crus (arrowhead) and resultant occlusion of the celiac artery (arrow). (b) Selective angiogram obtained via the right middle adrenal artery (white arrow) shows the reconstituted IPA (black arrow), which is supplied by middle-superior adrenal collateral vessels (arrowheads).
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Figure 12a. HCC in liver segment 1 supplied by the right IPA in a 56-year-old man with multinodular HCC in the entire liver. (a) Arterial phase dynamic CT scan shows multiple HCCs in the entire liver. Note the large HCC in liver segment 1 (*). (b) Arterial phase dynamic CT scan obtained after one session of TACE shows a recurrent tumor (arrowhead) in liver segment 1. Note the hypertrophied right IPA (arrow). (c) Selective angiogram obtained via the right IPA (arrow) shows hypervascular tumor staining (arrowhead) that corresponds to the recurrent tumor. (d) Precontrast CT scan obtained after two sessions of TACE shows the atrophied HCC (arrowhead) laden with iodized oil in liver segment 1.
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Figure 12b. HCC in liver segment 1 supplied by the right IPA in a 56-year-old man with multinodular HCC in the entire liver. (a) Arterial phase dynamic CT scan shows multiple HCCs in the entire liver. Note the large HCC in liver segment 1 (*). (b) Arterial phase dynamic CT scan obtained after one session of TACE shows a recurrent tumor (arrowhead) in liver segment 1. Note the hypertrophied right IPA (arrow). (c) Selective angiogram obtained via the right IPA (arrow) shows hypervascular tumor staining (arrowhead) that corresponds to the recurrent tumor. (d) Precontrast CT scan obtained after two sessions of TACE shows the atrophied HCC (arrowhead) laden with iodized oil in liver segment 1.
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Figure 12c. HCC in liver segment 1 supplied by the right IPA in a 56-year-old man with multinodular HCC in the entire liver. (a) Arterial phase dynamic CT scan shows multiple HCCs in the entire liver. Note the large HCC in liver segment 1 (*). (b) Arterial phase dynamic CT scan obtained after one session of TACE shows a recurrent tumor (arrowhead) in liver segment 1. Note the hypertrophied right IPA (arrow). (c) Selective angiogram obtained via the right IPA (arrow) shows hypervascular tumor staining (arrowhead) that corresponds to the recurrent tumor. (d) Precontrast CT scan obtained after two sessions of TACE shows the atrophied HCC (arrowhead) laden with iodized oil in liver segment 1.
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Figure 12d. HCC in liver segment 1 supplied by the right IPA in a 56-year-old man with multinodular HCC in the entire liver. (a) Arterial phase dynamic CT scan shows multiple HCCs in the entire liver. Note the large HCC in liver segment 1 (*). (b) Arterial phase dynamic CT scan obtained after one session of TACE shows a recurrent tumor (arrowhead) in liver segment 1. Note the hypertrophied right IPA (arrow). (c) Selective angiogram obtained via the right IPA (arrow) shows hypervascular tumor staining (arrowhead) that corresponds to the recurrent tumor. (d) Precontrast CT scan obtained after two sessions of TACE shows the atrophied HCC (arrowhead) laden with iodized oil in liver segment 1.
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Figure 13a. Huge HCC supplied by the left IPA in a 38-year-old man. (a) Arterial phase dynamic CT scan shows a hypertrophied left IPA (arrow). Note the huge HCC (*) in the left hepatic lobe. (b) Arterial phase dynamic CT scan obtained at the level of the hepatic dome shows the distal portion of the left IPA (arrowheads) supplying the HCC. (c) Selective inferior phrenic angiogram shows the hypertrophied left IPA (arrow) supplying the dome area of the HCC.
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Figure 13b. Huge HCC supplied by the left IPA in a 38-year-old man. (a) Arterial phase dynamic CT scan shows a hypertrophied left IPA (arrow). Note the huge HCC (*) in the left hepatic lobe. (b) Arterial phase dynamic CT scan obtained at the level of the hepatic dome shows the distal portion of the left IPA (arrowheads) supplying the HCC. (c) Selective inferior phrenic angiogram shows the hypertrophied left IPA (arrow) supplying the dome area of the HCC.
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Figure 13c. Huge HCC supplied by the left IPA in a 38-year-old man. (a) Arterial phase dynamic CT scan shows a hypertrophied left IPA (arrow). Note the huge HCC (*) in the left hepatic lobe. (b) Arterial phase dynamic CT scan obtained at the level of the hepatic dome shows the distal portion of the left IPA (arrowheads) supplying the HCC. (c) Selective inferior phrenic angiogram shows the hypertrophied left IPA (arrow) supplying the dome area of the HCC.
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Figure 14a. HCC supplied by the left IPA in a 41-year-old man. (a) Arterial phase dynamic CT scan shows three enhancing masses in the liver. (b) Selective celiac angiogram shows three areas of tumor staining in the liver. Note the faint tumor staining in the superior portion (arrowheads) of one HCC. (c) Selective inferior phrenic angiogram shows hypervascular tumor staining (arrowheads) from the left IPA (arrows) that corresponds to the faint staining seen on the celiac angiogram.
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Figure 14b. HCC supplied by the left IPA in a 41-year-old man. (a) Arterial phase dynamic CT scan shows three enhancing masses in the liver. (b) Selective celiac angiogram shows three areas of tumor staining in the liver. Note the faint tumor staining in the superior portion (arrowheads) of one HCC. (c) Selective inferior phrenic angiogram shows hypervascular tumor staining (arrowheads) from the left IPA (arrows) that corresponds to the faint staining seen on the celiac angiogram.
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Figure 14c. HCC supplied by the left IPA in a 41-year-old man. (a) Arterial phase dynamic CT scan shows three enhancing masses in the liver. (b) Selective celiac angiogram shows three areas of tumor staining in the liver. Note the faint tumor staining in the superior portion (arrowheads) of one HCC. (c) Selective inferior phrenic angiogram shows hypervascular tumor staining (arrowheads) from the left IPA (arrows) that corresponds to the faint staining seen on the celiac angiogram.
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Figure 15a. HCC supplied by the right IPA in a 65-year-old man. Pleural and pulmonary staining was noted at initial TACE. (a) Arterial phase image from right inferior phrenic angiography shows pleural and pulmonary staining (arrowheads). (b) Image from the late arterial phase shows the draining pulmonary veins (arrows) running along their courses into the left atrium. HCC staining (*) is also seen.
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Figure 15b. HCC supplied by the right IPA in a 65-year-old man. Pleural and pulmonary staining was noted at initial TACE. (a) Arterial phase image from right inferior phrenic angiography shows pleural and pulmonary staining (arrowheads). (b) Image from the late arterial phase shows the draining pulmonary veins (arrows) running along their courses into the left atrium. HCC staining (*) is also seen.
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Figure 16a. Retroperitoneal HCC seeding metastases supplied by the right IPA in a 46-year-old man who had undergone left lobectomy. (a) Arterial phase dynamic CT scan shows multiple seeding metastatic nodules (arrowheads) in the right retroperitoneal area. A left adrenal metastasis is also seen. (b) Selective right inferior phrenic angiogram shows hypervascular seeding metastases (arrowheads). Note the localized pleural and pulmonary staining (arrows) at the lateral aspect of the right lower lung base.
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Figure 16b. Retroperitoneal HCC seeding metastases supplied by the right IPA in a 46-year-old man who had undergone left lobectomy. (a) Arterial phase dynamic CT scan shows multiple seeding metastatic nodules (arrowheads) in the right retroperitoneal area. A left adrenal metastasis is also seen. (b) Selective right inferior phrenic angiogram shows hypervascular seeding metastases (arrowheads). Note the localized pleural and pulmonary staining (arrows) at the lateral aspect of the right lower lung base.
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Figure 17a. HCC exclusively supplied by the right IPA in a 40-year-old man. (a) Arterial phase dynamic CT scan shows a mass (*) in the posterior portion of the right hepatic lobe. The mass demonstrates peripheral nodular enhancement. (b) Portal phase dynamic CT scan shows gradual centripetal enhancement. (c, d) CTHA (c) and CTAP (d) images show no tumor enhancement. (e) Selective angiogram obtained via the right IPA shows hypervascular tumor staining (*). There was no tumor staining at hepatic angiography. On the CT scans, a vascular structure (arrowhead in a–d) is seen just posteromedial to the mass. The arrow in e indicates the vascular structure seen on the CT scans.
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Figure 17b. HCC exclusively supplied by the right IPA in a 40-year-old man. (a) Arterial phase dynamic CT scan shows a mass (*) in the posterior portion of the right hepatic lobe. The mass demonstrates peripheral nodular enhancement. (b) Portal phase dynamic CT scan shows gradual centripetal enhancement. (c, d) CTHA (c) and CTAP (d) images show no tumor enhancement. (e) Selective angiogram obtained via the right IPA shows hypervascular tumor staining (*). There was no tumor staining at hepatic angiography. On the CT scans, a vascular structure (arrowhead in a–d) is seen just posteromedial to the mass. The arrow in e indicates the vascular structure seen on the CT scans.
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Figure 17c. HCC exclusively supplied by the right IPA in a 40-year-old man. (a) Arterial phase dynamic CT scan shows a mass (*) in the posterior portion of the right hepatic lobe. The mass demonstrates peripheral nodular enhancement. (b) Portal phase dynamic CT scan shows gradual centripetal enhancement. (c, d) CTHA (c) and CTAP (d) images show no tumor enhancement. (e) Selective angiogram obtained via the right IPA shows hypervascular tumor staining (*). There was no tumor staining at hepatic angiography. On the CT scans, a vascular structure (arrowhead in a–d) is seen just posteromedial to the mass. The arrow in e indicates the vascular structure seen on the CT scans.
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Figure 17d. HCC exclusively supplied by the right IPA in a 40-year-old man. (a) Arterial phase dynamic CT scan shows a mass (*) in the posterior portion of the right hepatic lobe. The mass demonstrates peripheral nodular enhancement. (b) Portal phase dynamic CT scan shows gradual centripetal enhancement. (c, d) CTHA (c) and CTAP (d) images show no tumor enhancement. (e) Selective angiogram obtained via the right IPA shows hypervascular tumor staining (*). There was no tumor staining at hepatic angiography. On the CT scans, a vascular structure (arrowhead in a–d) is seen just posteromedial to the mass. The arrow in e indicates the vascular structure seen on the CT scans.
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Figure 17e. HCC exclusively supplied by the right IPA in a 40-year-old man. (a) Arterial phase dynamic CT scan shows a mass (*) in the posterior portion of the right hepatic lobe. The mass demonstrates peripheral nodular enhancement. (b) Portal phase dynamic CT scan shows gradual centripetal enhancement. (c, d) CTHA (c) and CTAP (d) images show no tumor enhancement. (e) Selective angiogram obtained via the right IPA shows hypervascular tumor staining (*). There was no tumor staining at hepatic angiography. On the CT scans, a vascular structure (arrowhead in a–d) is seen just posteromedial to the mass. The arrow in e indicates the vascular structure seen on the CT scans.
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Figure 18a. Hemoptysis due to cystic bronchiectasis in a 62-year-old man. (a) High-resolution chest CT scan shows cystic bronchiectasis (arrowheads) in the basal segment of the left lower lobe. Ground-glass opacities (*) in the right lower lobe indicate aspirated blood. (b) Contrast-enhanced chest CT scan shows a hypertrophied left IPA (arrow). (c) Selective angiogram obtained via the left IPA (arrow), which originates from the celiac trunk, shows pulmonary staining and draining pulmonary veins (arrowheads). Successful embolization of the bronchial arteries and left IPA with polyvinyl alcohol particles was performed. The patient had no further hemoptysis.
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Figure 18b. Hemoptysis due to cystic bronchiectasis in a 62-year-old man. (a) High-resolution chest CT scan shows cystic bronchiectasis (arrowheads) in the basal segment of the left lower lobe. Ground-glass opacities (*) in the right lower lobe indicate aspirated blood. (b) Contrast-enhanced chest CT scan shows a hypertrophied left IPA (arrow). (c) Selective angiogram obtained via the left IPA (arrow), which originates from the celiac trunk, shows pulmonary staining and draining pulmonary veins (arrowheads). Successful embolization of the bronchial arteries and left IPA with polyvinyl alcohol particles was performed. The patient had no further hemoptysis.
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Figure 18c. Hemoptysis due to cystic bronchiectasis in a 62-year-old man. (a) High-resolution chest CT scan shows cystic bronchiectasis (arrowheads) in the basal segment of the left lower lobe. Ground-glass opacities (*) in the right lower lobe indicate aspirated blood. (b) Contrast-enhanced chest CT scan shows a hypertrophied left IPA (arrow). (c) Selective angiogram obtained via the left IPA (arrow), which originates from the celiac trunk, shows pulmonary staining and draining pulmonary veins (arrowheads). Successful embolization of the bronchial arteries and left IPA with polyvinyl alcohol particles was performed. The patient had no further hemoptysis.
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Figure 19a. Bleeding after living donor liver transplantation in a 44-year-old woman. (a) Portal phase dynamic CT scan shows a perihepatic hematoma and two highly enhancing nodules (arrows) along the course of the right IPA. (b) Selective angiogram obtained via the right IPA shows a pseudoaneurysm with extravasation (arrow). Successful embolization of the right IPA with microcoils was performed.
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Figure 19b. Bleeding after living donor liver transplantation in a 44-year-old woman. (a) Portal phase dynamic CT scan shows a perihepatic hematoma and two highly enhancing nodules (arrows) along the course of the right IPA. (b) Selective angiogram obtained via the right IPA shows a pseudoaneurysm with extravasation (arrow). Successful embolization of the right IPA with microcoils was performed.
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Copyright © 2007 by the Radiological Society of North America.
