A 58-year-old man comes to the office with upper abdominal pain, fatigue, and anorexia. He says his symptoms began about a month ago and seem to be getting worse. The patient has a history of cirrhosis due to chronic hepatitis C. Physical examination shows cachexia and worsening ascites. Imaging studies reveal a large mass in the right hepatic lobe consistent with unresectable hepatocellular cancer. The patient is scheduled to undergo percutaneous embolization of the artery supplying the tumor. Contrast material administration into which of the following structures is most likely to visually enhance the artery prior to embolization?
Show Explanatory Sources
The vascular supply to the upper abdomen mainly comes from the celiac trunk (celiac artery), which is the first anterior branch of the abdominal aorta. The celiac trunk branches into the left gastric, common hepatic, and splenic arteries. The left gastric artery further divides into the esophageal and stomach branches, which supply blood to the abdominal esophagus and upper stomach. The splenic artery and its branches (dorsal pancreatic, short gastric, left gastro-omental, and greater pancreatic arteries) provide blood to the spleen, the gastric fundus, and part of the pancreas (Choice E).
The common hepatic artery further divides into the gastroduodenal and proper hepatic arteries. The gastroduodenal artery supplies blood to the pylorus, proximal duodenum, and pancreatic head (Choice B).
The proper hepatic artery divides into the left and right hepatic arteries, which provide arterial blood supply to the liver and would perfuse this patient's right hepatic lobe mass.
(Choice C) The inferior mesenteric artery branches off the abdominal aorta at the L3 level (inferior to both the celiac trunk and superior mesenteric artery). This artery provides blood supply to the colon from the splenic flexure to the upper rectum (eg, descending and sigmoid colon).
(Choice D) The inferior vena cava (IVC) is formed by the union of both common iliac veins and drains blood from the lower part of the body to the right atrium. Other veins that empty into the IVC include the hepatic, renal, lumbar, and gonadal veins.
(Choice F) The superior mesenteric artery branches off the abdominal aorta inferior to the origin of the celiac trunk. The superior mesenteric artery supplies blood to part of the pancreas and the intestine from the lower part of the duodenum to the first two-thirds of the transverse colon.
Educational objective:
The celiac trunk is the first main branch of the abdominal aorta; it provides oxygenated blood to the spleen, stomach, liver, abdominal esophagus, and parts of the duodenum and pancreas. The proper hepatic artery branches off the common hepatic artery from the celiac trunk and provides arterial blood supply to the liver.