Aberrant Right Gastric Vein Directly Communicating with Left Portal Vein System

Abstract

In 3 patients with primary hepatic malignancies, a communication between the right gastric vein and the left portal vein system was recognized at angiography. The right gastric vein entered directly into the left lateral portal veins in 2 patients and into the left medial portal veins in one. Portal angio-CT performed in one patient demonstrated a specific defect only in the left lateral superior area of the liver, consistent with the segmental opacification of the portal vein branch recognized on the angiogram. This rare communication was seen in 3 (1.5%) of 200 consecutive patients who underwent celiac angiography and is most likely an anomaly in which the right gastric vein directly enters the left portal vein instead of the portal vein trunk. When interpreting a filling defect not associated with a mass lesion on portal angio-CT for hepatic neoplasms or the right gastric vein communicating with the left portal vein system on the angiogram, this particular anomaly should be considered.

A Case Simultaneously Presenting with a Rare Portal Collateral Pathway and Left Gastric Venous Anomaly

“…These findings may indicate that the course of the left gastric vein observed in the present case was congenital, and became prominent due to increased portal pressure caused by liver cirrhosis. There have been clinical reports describing an abnormal course and distribution of the left gastric vein, particularly anastomosis of the left gastric vein to the left branch of the portal vein (Kokubo et aL, 1990;Tajima et aL, 1992;Takayasu et aL, 1990). However, these report have only given angiographic findings and lacked detailed morphological descriptions.…”

“…However, only a few opportunities exist to dissect and observe such cases during the dissecting practice (Yamada, 1934;Kubota et aL, 1957;Sakamoto et aL, 1997). Clinically, although there have been reports on the observations of portal collateral routes using imaging diagnostic systems, details of these routes remain unknown (Kokubo et aL, 1990;Tajima et aL, 1992;Takayasu et aL, 1990).…”

“…However, only a few opportunities exist to dissect and observe such cases during the dissecting practice (Yamada, 1934;Kubota et aL, 1957;Sakamoto et aL, 1997). Clinically, although there have been reports on the observations of portal collateral routes using imaging diagnostic systems, details of these routes remain unknown (Kokubo et aL, 1990;Tajima et aL, 1992;Takayasu et aL, 1990).On the other hand, the left gastric vein forms the coronary vein, together with the right gastric vein (Miki, 1973). Embryologically, this is derived from the vitelline veins and is said to be a residue of the left portal vein (Miyaki, 1973(Miyaki, , 1978(Miyaki, , 1987.…”

Aberrant left gastric vein directly draining into the liver

“…In such a case, the aberrant vein is termed the ''left portal vein'' (Miyaki et al, 1987). The aberrant left gastric vein is very important not only ontogenetically and phylogenetically, but also clinically (Ohashi et al, 1997;Tajima et al, 1992;Takayasu et al, 1990). The present author has already reported a case with induced development of a rare portal collateral vein due to increased portal pressure induced by liver cirrhosis and an abnormal distribution of the left gastric vein (Ohkubo and Iimura, 1997).…”

“…Cases of anastomosis of the right or left gastric vein to a branch of the portal vein in the liver have been reported clinically, following the development of diagnostic imaging equipment (Kokubo et al, 1990;Ohashi et al, 1997;Tajima et al, 1992;Takayasu et al 1990). In those reports, the patients frequently had some type of liver or gastric injury.…”