Celiacomesenteric trunk

Name the anatomic variant and why it is important • Xray of the Week

Figure 1. CT Scan - Name the anatomic variant and why it is important.

Figure 2. Celiacomesenteric trunk. CT Scan - 3D angiogram image shows a common trunk (red arrow) which gives rise to the superior mesenteric artery and the celiac axis. Axial and sagittal CTA images: Superior mesenteric artery (green arrow) and celiac axis (yellow arrow) originating a common trunk.

Figure 3. Celiacomesenteric trunk. Sagittal CT Scan and 3D angiogram in a different patient which shows a large common trunk giving rise to the superior mesenteric artery and the celiac axis.

Discussion:

The celiac trunk classically gives off three main branches: the left gastric, splenic, and common hepatic arteries. In 30% of the population though variations exist and included within these is the incidence of a celiacomesenteric trunk (CMT) in which the superior mesenteric artery (SMA) also branches from a common trunk with the celiac artery (Figs.1-3). The incidence of this anomaly is reported to be 0.5-3.4% (1-3). In total there have been four different types of CMT with the classic type being recognized as a common trunk containing the 3 branches of the celiac artery along with the SMA (2). In even rarer cases, an embryonic anastomotic branch may persist between the celiac and SMA, known as the arc of Buhler (AOB). Enlargement of this anastomosis can occur as can formation of aneurysms leading to occlusion of the celiac artery (5). CTA is often performed in patients undergoing abdominal procedures, and especially those concerning pancreatic, hepatobiliary, and other gastric neoplasms and masses. Multidetector computed tomography angiography (MDCT) remains the superior method for recognizing anatomical variants within the arterial and venous systems (4). It is crucial to identify anatomical variants such as the one described here prior to any open surgical, laparoscopic, or interventional procedures in order to avoid potential complications.

References:

1. D’Souza D. Celiac artery | Radiology Reference Article | Radiopaedia.org. Radiopaedia. https://radiopaedia.org/articles/coeliac-artery?lang=us. Accessed April 13, 2020. 2. Muzio BD. Celiacomesenteric trunk | Radiology Reference Article | Radiopaedia.org. Radiopaedia. https://radiopaedia.org/articles/coeliacomesenteric-trunk?lang=us. Accessed April 13, 2020. 3. Ramesh Babu CS, Joshi S, Gupta KK, Gupta OP. Celiacomesenteric trunk and its variants a multidetector row computed tomographic study. Journal of the Anatomical Society of India. 2015;64(1):32-41. doi:10.1016/j.jasi.2015.04.007 4. Winston CB, Lee NA, Jarnagin WR, et al. CT Angiography for Delineation of Celiac and Superior Mesenteric Artery Variants in Patients Undergoing Hepatobiliary and Pancreatic Surgery. American Journal of Roentgenology. 2007;189(1):W13-W19. doi:10.2214/AJR.04.1374 5. Kageyama Y, Kokudo T, Amikura K, Miyazaki Y, Takahashi A, Sakamoto H. The arc of Buhler: special considerations when performing pancreaticoduodenectomy. Surg Case Rep. 2016;2. doi:10.1186/s40792-016-0149-2

Neal Shah is a medical student at The Edward Via College of Osteopathic Medicine (VCOM)–Carolinas and intends on completing his residency within the field of radiology. Prior to medical school, he completed his undergraduate studies at the University of North Carolina at Chapel Hill where he majored in economics and chemistry. During his 4 years there he worked in UNC’s Biomedical Research Imaging Center where he helped develop formulations for iron-oxide nanoparticles used for MRI; it was here that his love for the field of radiology developed. He eventually wishes to also pursue his MBA and hopes to use it to help advance the field of medicine in terms of medical innovation.

UPDATE: Dr. Shah is a radiology resident at Vanderbilt Radiology

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Kevin M. Rice, MD is the president of Global Radiology CME

Dr. Rice is a radiologist with Renaissance Imaging Medical Associates. and is currently the Vice Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.

Follow Dr. Rice on Twitter @KevinRiceMD

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