J Korean Soc Radiol.  2012 Oct;67(4):257-261. 10.3348/jksr.2012.67.4.257.

Focal Fat Deposition Developed in the Segment IV of the Liver Following Gastrectomy Mimicking a Hepatic Metastasis: Two Case Reports

• Sohn B
• Lim JS
• Hyung WJ
• Kim MJ
• Kim KW

• KMID: 1439537
• DOI: http://doi.org/10.3348/jksr.2012.67.4.257

Abstract

We present two cases of focal fat deposition developed at the posterior area of the segment IV in the liver, following gastrectomy in patients with gastric cancer. There was no focal lesion in this area of the liver at preoperative computed tomography (CT) in both cases, and the aberrant right gastric vein (ARGV) was found on the retrospective review of this CT. After gastrectomy, a focal, low-attenuating lesion was developed in this area on a follow-up CT in both cases, which was confirmed as a focal fat deposition, by other imaging studies. In addition to its typical imaging findings, confirmation of the presence of the ARGV also supported this lesion to be a focal fat deposition. Furthermore, understanding of our cases may be of help to prevent us from unnecessary invasive procedures, such as liver biopsy.

MeSH Terms

Biopsy
Follow-Up Studies
Gastrectomy
Humans
Liver
Retrospective Studies
Stomach Neoplasms
Veins

Figure

• 

  Fig. 1 A 44-year-old woman who underwent total gastrectomy due to advanced gastric cancer. A. Preoperative axial CT image obtained during the portal venous phase demonstrates no focal lesion in the segment IV of the liver. B. Preoperative oblique CT image using the maximum intensity projection technique demonstrates an enhancing vascular structure (arrows) at the posterior area of the segment IV, which was found to originate from the aberrant right gastric vein on the other maximum intensity projection images. C. Follow-up CT image obtained one year after gastrectomy demonstrates a 2.5-cm, low-attenuating lesion (arrows) newly developed in the segment IV. Note an enhancing vascular structure within this lesion. D, E. Chemical shift magnetic resonance images confirm that this lesion (arrows) is focal fat deposition by identifying signal drop of this lesion on the opposed phase image (D) in comparison with the in-phase image (E).

• 

  Fig. 2 A 69-year-old man who underwent subtotal gastrectomy due to advanced gastric cancer. A. Preoperative axial CT image obtained during the portal venous phase demonstrates no focal lesion in the segment IV of the liver. B. Preoperative coronal CT image using the maximum intensity projection technique demonstrates the ARGV (arrows) that drains into the posterior area of segment IV. The common hepatic artery is also visualized (arrowheads). C. Follow-up CT image obtained six months after gastrectomy demonstrates a 2.9-cm, low-attenuating lesion (arrows) newly developed in the segment IV. Note an enhancing vascular structure within this lesion. D. On the one-year follow-up CT image, the lesion becomes to be smaller and less distinct, due to partial recovery of attenuation at the posterior part of the lesion (arrows). Note.-ARGV = aberrant right gastric vein

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