CASE 15224 Published on 26.11.2017

An uncommon anatomic variant of visceral arteries

Section

Cardiovascular

Case Type

Anatomy and Functional Imaging

Authors

Christopher Moosavi, MD, Jaimin Shah, MD, Bertrand Janne d'Othée, MD, MPH, MBA

University of Maryland Medical Center, University of Maryland School of Medicine, Radiology, Division of Vascular & Interventional Radiology; 22 S. Greene Street, N2 W74 21201 Baltimore, United States of America; Email: bjanne@post.harvard.edu

Patient

72 years, female

Categories

Area of Interest Abdomen, Arteries / Aorta, Vascular, Abdominal wall ; Imaging Technique CT, Catheter arteriography

Procedure Normal variants ; Special Focus Congenital ;

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Clinical History

A 72-year-old woman with acute upper gastrointestinal bleeding (haematemesis) and pancreatic head cancer.

Imaging Findings

1. A single arterial trunk arising directly from the aorta bifurcates early and gives both cranially- and caudally-oriented branches.

2. One of the cranial branches follows a curved pathway running counterclockwise from the left towards the right upper quadrant (arrows in Figure 4).

Discussion

The most prominent anomaly seen is a single arterial trunk arising directly from the aorta and bifurcating early into a cranial and a caudal branch, respectively the celiac trunk (cranially oriented) and the superior mesenteric artery (SMA) (caudally oriented). This trunk is thus a celiomesenteric trunk, an anatomic variant (incidence estimated in the 0.25-2.7% range) [1-2]. Rarely, a celiomesenteric may share a common aortic origin with a renal trunk [3].

The presence of a celiomesenteric trunk has been associated with aneurysms and with median arcuate ligament compression [2]. Thrombosis of the celiomesenteric trunk may also occur and cause severe, life-threatening intestinal ischaemia involving the liver, spleen, and from the stomach up to the transverse colon [4]. The extent and consequences of intestinal ischaemia might be mitigated depending on whether the middle colic artery is absent and thus not connected to the celiomesenteric trunk [5]. In the present case, the middle colic could be visualised on selective contrast injections of the celiomesenteric trunk branches (Figure 4).

A second anatomic variant is also present in this case (Figure 5): the left gastric artery (straight red arrow) continues counterclockwise as a replaced left hepatic artery (curved yellow arrows) (incidence: 3-11%).

Differential Diagnosis List

1. Celiomesenteric trunk. 2. Replaced left hepatic artery.

Celiomesenteric and renal trunk [5]

Middle mesenteric artery [6]

Splenomesenteric trunk

Final Diagnosis

1. Celiomesenteric trunk. 2. Replaced left hepatic artery.

References

[1] Caviar S, Sehirli U, Pekin B. (1997) Celiacomesenteric trunk. Clin Anat 10(4):231-4. (PMID: 9213038)

[2] Lee V, Alvarez MD, Bhatt S, Dogra VS. (2011) Median arcuate ligament compression of the celiomesenteric trunk. J Clin Imaging Sci 1:8. (PMID: 21915389)

[3] Sarlon-Bartoli G, Magnan PE, Lépidi H, Bartoli MA. (2014) Celiomesenteric and renal common trunk associated with distal thoracic aorta coarctation and three saccular aneurysms. J Vasc Surg 59(5):1432. (PMID: 24767274)

[4] Lovisetto F, Finocchiaro GDL, Stancampiano P, Corroding, C, De Cesare F, Geraci O, Manzi M, Arceci F. (2012) Thrombosis of the celiacomesenteric trunk: Report of a case. World J Gastroenterol 18(29):3917-20. (PMID: 22876046)

[5] Dewitt RC, Cooley DA. (2004) Celiomesenteric trunk compression and absence of collateral vessels in the large intestine--a case report. Vasc Endovascular Surg 38(5):461-3. (PMID: 15490045)

Case information