PMC6159272_01
Spectral Doppler tracings at the time of initial presentation show abnormal waveforms with blunting of the systolic upstrokes, although the peak Vs and RI remained normal. (a) Main hepatic artery waveform. (b) LHA waveform. CHA, common hepatic artery; LHA, left hepatic artery; RI, resistive index; Vd, diastolic velocity; Vs, systolic velocity.
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Spectral Doppler sonography demonstrated abnormal waveforms with tardus parvus-like morphology within the main and left hepatic arteries, both of which demonstrated blunting of the systolic upstroke (Figure 1a).
Images from CT angiography. (a) Curved planar reformation, extending from the aorta through the celiac artery and the main hepatic artery, showing a haemodynamically significant celiac artery stenosis (long arrow) and no stenosis in the region of the surgical anastomosis in the main hepatic artery (short arrow). No arterial calcification is evident. (b) Volume rendered image demonstrates the transplant hepatic artery (arrow) and the visceral vasculature. No significant collateral vessels are present. The celiac artery stenosis is not well visualized in this frontal projection.
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CT angiography 2 days thereafter revealed not only a normal main hepatic artery and patent surgical arterial anastomosis, but also an unexpected, haemodynamically significant stenosis (exceeding 50% diameter) at the origin of the celiac artery (Figure 2).