CT imaging of third inflow cases: a hidden cause of surgical complications and liver pseudolesions

Abstract

Third inflow refers to the additional blood supply to the liver from a third source, apart from its dual blood supply. Aberrant right and left gastric veins, Sappey and Barlow veins, and the parabiliary venous system are considered the most significant examples of third inflow. Clinically, the third inflow is important due to its association with hepatic pseudolesions and its role in increasing surgical complication risks in hepatobiliary and gastric procedures. Our case series includes 8 cases of aberrant left gastric vein (ALGV) and 1 case of a Sappey vein. In addition to presenting examples of ALGV and Suppey vein, we also highlight ischemic complications of the liver observed in a liver transplant donor and a gastric cancer case. Our aim is to emphasize ALGV-related surgical risks and the importance of assessing vascular variations in preoperative imaging.