Focal fatty infiltration in the posterior aspect of hepatic segment IV: Relationship to pancreaticoduodenal venous drainage

OBJECTIVE: We aimed to investigate the relationship between fatty infiltration in the posterior aspect of hepatic segment IV and pancreaticoduodenal venous drainage. METHODS: Pancreaticoduodenal arteriography was performed in 21 patients who had nontumorous portal perfusion defects in the posterior aspect of hepatic segment IV, as demonstrated on CT during arterial portography (CTAP). RESULTS: In 10 patients, pancreaticoduodenal arteriography showed an aberrant nonportal vessel with flow toward the hepatic hilum in the venous phase. Four of the 10 patients with nonportal vessels from the pancreaticoduodenal arterial system had fatty infiltration in segment IV. In three of these four patients, the fatty infiltration was focal and localized to that area. On the other hand, none of the 11 patients without nonportal vessels from the pancreaticoduodenal arterial system had fatty infiltration in the regions corresponding to the nontumorous portal perfusion defects on CTAP. Moreover, three patients with diffuse fatty liver had a focal nonfatty area in segment IV. CONCLUSIONS: Focal fatty infiltration in the posterior aspect of hepatic segment IV seems to be related to pancreaticoduodenal venous drainage. (C) 2000 by Am. Coll. of Gastroenterology.