Rare origin of the right inferior phrenic artery from the anterior inferior pancreaticoduodenal artery in a patient with hepatocellular carcinoma.
Kotaro Hosoi, Tomoya Matsumoto, Yu Fujiki et al.
✦ AI-curated · Sources linked
Case in brief
A woman in her 80s with ruptured hepatocellular carcinoma underwent emergency transcatheter arterial embolization. CT did not show the right inferior phrenic artery (RIPA) at its usual origins and suggested a source in the superior mesenteric arterial system. Although right hepatic arteriography showed tumor staining and extravasation, part of the tumor remained unstained after hepatic arterial embolization. Selective angiography identified the RIPA arising directly from the anterior inferior pancreaticoduodenal artery and supplying the tumor. Embolization of the RIPA eliminated tumor staining; the patient remained hemodynamically stable and was transferred the next day.
What made this case unusual
The RIPA arose directly from the anterior inferior pancreaticoduodenal artery and supplied the HCC. Its anterior division also gave rise to a branch crossing the midline toward the left subdiaphragmatic region, consistent with a left inferior phrenic arterial branch.
Diagnostic / clinical pearl
Persistent unstained tumor after hepatic arterial embolization can indicate extrahepatic arterial supply. When CT suggests an atypical source, selective angiography of the relevant arterial system can identify a variant vessel and its tumor contribution.
Why it matters
Recognizing this arterial origin is relevant to mapping tumor supply and planning embolization in patients with HCC.