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 infiltrat ion in the posterior aspect of hepatic segment IV and pancreaticoduodenal v enous drainage. METHODS: Pancreaticoduodenal arteriography was performed in 21 patients who had nontumorous portal perfusion defects in the posterior aspect of hepati c segment IV, as demonstrated on CT during arterial portography (CTAP). RESULTS: In 10 patients, pancreaticoduodenal arteriography showed an aberra nt nonportal vessel with flow toward the hepatic hilum in the venous phase. Four of the 10 patients with nonportal vessels from the pancreaticoduodena l arterial system had fatty infiltration in segment IV. In three of these f our patients, the fatty infiltration was focal and localized to that area. On the other hand, none of the 11 patients without nonportal vessels from t he pancreaticoduodenal arterial system had fatty infiltration in the region s corresponding to the nontumorous portal perfusion defects on CTAP. Moreov er, three patients with diffuse fatty liver had a focal nonfatty area in se gment IV. CONCLUSIONS: Focal fatty infiltration in the posterior aspect of hepatic se gment IV seems to be related to pancreaticoduodenal venous drainage. (C) 20 00 by Am. Cell. of Gastroenterology.