The left inferior phrenic artery arising from left hepatic artery or left gastric artery: radiological and anatomical correlation in clinical cases and cadaver dissection Rei Tanaka, 1 Kenji Ibukuro, 1 Keiichi Akita 2 1 Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan 2 Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-8519, Japan Abstract Background: The purpose of this study is to assess angiographic and CT appearance of left inferior phrenic artery (LIPA) arising from left hepatic or left gastric artery and to recognize its specific anatomical location with the help of cadaver dissection. Methods: We retrospectively reviewed 761 abdominal angiographies and found 13 patients (1.7%) with LIPA arising from left hepatic or left gastric artery. We classified those origins and assessed radiological features. We also presented a cadaver dissection to identify anatomical location of LIPA arising from left hepatic artery. Results: The origin of the LIPA was classified as follows: (a) left hepatic artery: four, (b) accessory left gastric artery: one, (c) accessory left hepatic artery: three, and (d) left gastric artery: five patients. The proximal portion was located in gastrohepatic ligament and its distal portion was located in front of esophageal hiatus. In a cadaver dissection, the proximal portion ascends along ligamentum venosum and distal portion courses along superior aspect of left hemi diaphragm in front of esophagus. Conclusion: The LIPA rarely arises from left hepatic or left gastric artery. The proximal portion was located in gastrohepatic ligament and the distal portion runs in front of the esophageal hiatus. Key words: Inferior phrenic artery—Anomaly— Ligamentum venosum—Gastrohepatic ligament— Diaphragm It is well known that the left inferior phrenic artery (LIPA) arises from celiac artery or abdominal aorta [1, 2]; however, the LIPA rarely arises from left hepatic artery (LHA) or left gastric artery (LGA). The incidence of the LIPA arising from hepatic artery is reported as follows: 0.6% (proper HA) [3], 0% (LHA) [4], 0.3% (LHA) [2], 0.2% (LHA) [1], 1% (proper HA) [5], 2% (LHA) [6]. The incidence of the LIPA arising from LGA is reported as follows: 16% [3], 2.9% [4], 2.5% [2], 2.6% [1], 2% [5]. Because of its rarity, the angiographic and CT appearance of the LIPA arising from LHA or LGA have not been well documented [6]. We retrospectively reviewed 761 patients who underwent abdominal artery angiography and found 13 patients with the LIPA arising from LHA or the distal portion of LGA. We classified these LIPA based on its origin and reported its anatomical pathway based on the angiography and/or CT scan. We also presented a cadaver dissection with the LIPA arising from LHA to correlate its macro anatomy and the radiological images obtained by the clinical patients for its specific location. Materials and methods Clinical study We performed abdominal artery angiography including celiac artery angiography in 761 patients during 3 years between 2001 and 2003. The digital subtraction Correspondence to: Kenji Ibukuro; email: kj-ibkr@qd6.so-net.ne.jp ª Springer Science+Business Media, LLC 2007 Published online: 24 May 2007 Abdominal Imaging Abdom Imaging (2008) 33:328–333 DOI: 10.1007/s00261-007-9249-6