Rare Anatomic Variation: The Hepatosplenomesentericophrenic Trunk

The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.

The Artery of von Haller

BACKGROUND: Although recognized since the 18th century, radiculomedullary arteries (RMAs) originating from upper thoracic intersegmental arteries are generally considered to be inconstant branches of little clinical importance. Yet, such vessels are commonly observed during spinal angiography. OBJECTIVE: To evaluate the angiographic prevalence of upper thoracic RMAs, in particular, branches supplying the anterior spinal artery (ASA). METHODS: Fifty spinal angiograms were reviewed. Anterior and posterior RMAs originating in the upper thoracic region (T3 to T7) were recorded. The level of origin of the artery of Adamkiewicz (T8 to L3) was also noted. RESULTS: Forty-three patients (86%) had at least 1 ASA contributor between T3 and T7. Of the other 7 patients, 4 had one at an immediately adjacent level (T2 or T8). The most frequent origin of upper thoracic anterior RMAs was left T5 (n = 10). Only left T9 (n = 12) and left T8 (n = 11) were more common. When combining the left and right sides, an ASA contributor was more frequent at T5 (n = 16) than at any other level (n = 15 for T9, n = 14 for T8). The sum of ASA contributors at T4 and T5 (n = 27) represented 54% of all upper thoracic anterior RMAs, and 23% of all anterior RMAs between T3 and L3. CONCLUSION: A significant upper thoracic anterior RMA distinct from the artery of Adamkiewicz appears to be a constant anatomic feature, which undermines the classic concept of an arterial watershed zone in the thoracic region. We propose to name this artery after Albrecht von Haller, who documented its existence in 1754.