Wandering spleen torsion with portal vein thrombosis: A case report.

BACKGROUND: Wandering spleen is rare clinically. It is characterized by displacement of the spleen in the abdominal and pelvic cavities and can have congenital or acquired causes. Wandering spleen involves serious complications, such as spleen torsion. The clinical symptoms range from asymptomatic abdominal mass to acute abdominal pain. Surgery is required after diagnosis. Cases of wandering spleen torsion with portal vein thrombosis (PVT) are rare. There is no report on how to eliminate PVT in such cases. CASE SUMMARY: Ultrasound and computed tomography revealed a diagnosis of wandering spleen torsion with PVT in a 31-year-old woman with a history of childbirth 16 mo previously who received emergency treatment for upper abdominal pain. She recovered well after splenectomy and portal vein thrombectomy combined with continuous anticoagulation, and the PVT disappeared. CONCLUSION: Rare and nonspecific conditions, such as wandering splenic torsion with PVT, must be diagnosed and treated early. Patients with complete splenic infarction require splenectomy. Anticoagulation therapy and individualized management for PVT is feasible.

PPARγ affects nitric oxide in human umbilical vein endothelial cells exposed to Porphyromonas gingivalis.

OBJECTIVE: Porphyromonas gingivalis induces nitric oxide (NO) synthesis in human umbilical vein endothelial cells (HUVECs). Peroxisome proliferator-activated receptor (PPARγ) has an anti-inflammation function, and its involvement in this NO induction process requires elucidation. Here, we focused on PPARγ expression in HUVECs exposed to P. gingivalis, and investigated its effects on NO synthesis. MATERIALS AND METHODS: HUVECs were time-dependently stimulated by P. gingivalis W83 for 0-24h. PPARγ expression was assessed at the mRNA and protein levels, and PPARγ activation was measured using dual-luciferase reporter assays. NO synthesis and NO synthase (NOS) expression in response to P. gingivalis were examined in HUVECs pretreated with representative PPARγ agonist (15-deoxy-Δ12,14-prostaglandin J2 10µM) or antagonist (GW9662 10µM). In addition, NO synthesis and NOS expression in the P. gingivalis infected and control groups were detected. RESULTS: The PPARγ mRNA level in HUVECs increased after exposure to P. gingivalis for 1h and its protein level increased at 2h. Luciferase-induced PPARγ increased in P. gingivalis-exposed HUVECs. NO synthesis in the infected group at 4h, and in the PPARγ-activated group at 8h, was higher than that in controls. Inducible NOS increased in the infected and PPARγ-activated groups at 4 and 8h. The total endothelial NOS (eNOS) and phospho-eNOS levels were lower in the infected group than controls, but did not change in the PPARγ-activated group. CONCLUSIONS: Activated PPARγ induces NO generation through the NOS pathway in HUVECs exposed to P. gingivalis.

[Effect of peroxisome proliferator-activated receptor-γ on endothelial cells oxidative stress induced by Porphyromonas gingivalis].

OBJECTIVE: To detect the degree of oxidative stress in the process when Porphyromonas gingivalis (P. gingivalis) stimulates human vascular endothelium, And to investigate the effect of peroxisome proliferator-activated receptor(PPAR)γ on oxidative stress during this process. METHODS: Human vascular endothelial cells (HVECs) line EA.hy926 (American Type Culture Collection ,United States) was cultured in high glucose Dulbecco's modified eagle medium (DMEM). Four groups were designed: control group, P. gingivalis infected group, PPARγ activated group and PPARγ blocked group. In control group HVECs were cultured with only DMEM. In P. gingivalis infected group, HVECs were time-dependently stimulated by P. gingivalis W83 from 0 to 12 h. In PPARγ activated group or PPARγ blocked group, PPARγ was pre-activated or blocked by a representative PPARγ agonist(15d-PGJ2 10 µmol/L) or antagonist (GW966210 µmol/L) 30 minutes before the cells were stimulated by P. gingivalis. At 0, 0.5, 1, 1.5, 2, 4, 8, and 12 h, the culture medium was collected individually and centrifuged, and the supernatant was stored for assay. Glutathione peroxidase (GSH-PX) and malondialdehyde (MDA) were analysed by enzyme-linked immunosorbent assay. Cellular reactive oxygen species (ROS) were detected through 2',7'-dichlorofluorescin diacetate (DCFA-DA) fluorescent probe at various time points of the different groups. RESULTS: In P. gingivalis infected group, the levels of GSH-PX [(5.56±0.97) µmol/L] and MDA [(0.84±0.18) nmol/L] were significantly higher than those in control group [GSH-PX(4.71±0.64) µmol/L, MDA (0.59±0.18) nmol/L)]. The levels of GSH-PX and MDA in PPARγ activated group [GSH-PX (5.38±0.84) µmol/L, MDA (0.84±0.22) nmol/L] and in PPARγ blocked group [GSH-PX (5.37±0.76) µmol/L, MDA (0.85±0.14) nmol/L] were significantly higher than those in control group (P<0.05). In the PPARγ activated group, the levels of GSH-PX at 0.5 and 8 h were significantly higher than those from 1.5 h to 4 h (P<0.05), while no difference was observed on the MDA levels at different time points. There was no significant difference at various time points for the levels of GSH-PX and MDA in PPARγ blocked group. The level of cellular ROS detected by DCFH-DA in P. gingivalis infected group was significantly higher than that in control group (10 108.65 ± 1 805.18 vs. 6 049.06 ± 1 199.19,P<0.05). No difference was observed between PPARγ activated group (7 120.94±1 447.30) or PPARγ blocked group (6 727.35±1 483.68) and control group. CONCLUSION: Oxidative stress happens when P. gingivalis stimulates human vascular endothelium. PPARγ may involve in modulating oxidative stress during this process.

Thymosin ß4 promotes hepatoblastoma metastasis via the induction of epithelial-mesenchymal transition.

Hepatoblastoma (HB) is the most common malignant hepatic tumor in children and complete surgical resection offers the highest possibility for cure in this disease. Tumor metastasis is the principle obstacle to the development of efficient treatments for patients with HB. The present study aimed to measure the expression levels of thymosin ß4 (Tß4) in liver samples from patients with HB and to investigate the involvement of Tß4 in HB metastasis. The expression of Tß4 was significantly higher in liver samples from patients with metastatic HB and in the HepG2 metastatic HB cell line, compared with that in adjacent healthy liver samples and in the L02 healthy hepatic cell line. By contrast, the expression levels of epithelial-cadherin (E-cadherin) and cytosolic accumulation of ß-catenin, the two most prominent markers involved in epithelial-mesenchymal transition (EMT), were reduced in liver specimens from patients with metastatic HB compared with that of healthy adjacent control tissue. HepG2 cells were transfected with small interfering-RNA in order to downregulate Tß4 gene expression. This resulted in a reduced cell migratory capacity compared with control cells. Tß4 gene expression knockdown significantly inhibited transforming growth factor ß1-mediated-EMT in vitro by upregulating the expression of E-cadherin. The results of the present study suggested that Tß4 may promote HB metastasis via the induction of EMT, and that Tß4 may therefore be a target for the development of novel treatments for patients with HB.

Comparison of acoustic radiation force impulse imaging and transient elastography for non-invasive assessment of liver fibrosis in patients with chronic hepatitis B.

The aims of this study were to compare the performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis in patients with chronic hepatitis B and to evaluate the impact of elevated alanine transaminase levels on liver stiffness assessment using ARFI elastography. One hundred eighty consecutive patients with chronic hepatitis B were enrolled in this study and evaluated with respect to histologic and biochemical features. All patients underwent ARFI elastography and TE. ARFI elastography and TE correlated significantly with histologically assessed fibrosis (r = 0.599, p < 0.001, for ARFI elastography; r = 0.628, p < 0.001, for TE) and necro-inflammatory activity (r = 0.591, p < 0.001, for ARFI elastography; r = 0.616, p < 0.001, for TE). Areas under the receiver operating characteristic curves for ARFI elastography and TE were 0.764 and 0.813 (p = 0.302, ≥stage 2), 0.852 and 0.852 (p = 1.000, ≥stage 3) and 0.825 and 0.799 (p = 0.655, S = 4), respectively. The optimum cutoff values for ARFI elastography were 1.63 m/s for stage ≥2, 1.74 m/s for stage ≥3 and 2.00 m/s for stage 4 in patients for whom alanine transaminase levels were evaluated. The cutoff values decreased to 1.24 m/s for ≥ stage 2, 1.32 m/s for ≥ stage 3 and 1.41 m/s for stage 4 in patients with normal alanine transaminase levels. ARFI elastography may be a reliable method for diagnosing the stage of liver fibrosis with diagnostic performance similar to that of TE in patients with chronic hepatitis B. In addition, liver stiffness values obtained with ARFI elastography, like those obtained with TE, may be influenced by alanine transaminase levels.

Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease using acoustic radiation force impulse elastography.

OBJECTIVES: To investigate the diagnostic performance of the acoustic radiation force impulse (ARFI) elastography for the assessment of the liver fibrosis in alcoholic liver disease (ALD). METHODS: We included 112 patients with ALD in whom liver biopsy, ARFI elastography, and aspartate-to-platelet ratio index (APRI) measurements were performed. RESULTS: ARFI elastography correlated significantly with histological fibrosis (r = 0.685, P < 0.001) in patients with ALD. The diagnostic accuracies expressed as areas under receiver operating characteristic (AUROC) curves for ARFI elastography and APRI were 0.846 and 0.763 for the diagnosis of significant fibrosis (S ≥ 2), 0.875 and 0.688 for the diagnosis of severe fibrosis (S ≥ 3), and 0.893 and 0.648 for the diagnosis of liver cirrhosis, respectively. The AUROC values of ARFI elastography were significantly better than those of APRI for predicting severe fibrosis (P = 0.02) and cirrhosis (P = 0.04). The optimum cutoff values for ARFI elastography were 1.33 m/s for S ≥ 2, 1.40 m/s for S ≥ 3, and 1.65 m/s for S = 4 in patients with elevated alanine aminotransferase (ALT) levels; these decreased to 1.24 m/s for S ≥ 2, 1.27 m/s for S ≥ 3, and 1.41 m/s for S = 4 in patients with normal ALT. CONCLUSION: ARFI elastography is an acceptable method for predicting the severity of fibrosis in patients with ALD. ARFI elastography is influenced by elevated aminotransferase levels in ALD.

[A comparative study of Da Vinci robot system with video-assisted thoracoscopy in the surgical treatment of mediastinal lesions].

BACKGROUND: In recent years, Da Vinci robot system applied in the treatment of intrathoracic surgery mediastinal diseases become more mature. The aim of this study is to summarize the clinical data about mediastinal lesions of General Hospital of Shenyang Military Region in the past 4 years, then to analyze the treatment effect and promising applications of da Vinci robot system in the surgical treatment of mediastinal lesions. METHODS: 203 cases of mediastinal lesions were collected from General Hospital of Shenyang Military Region between 2010 and 2013. These patients were divided into two groups da Vinci and video-assisted thoracoscopic surgery (VATS) according to the selection of the treatments. The time in surgery, intraoperative blood loss, postoperative drainage amount within three days after surgery, the period of bearing drainage tubes, hospital stays and hospitalization expense were then compared. RESULTS: All patients were successfully operated, the postoperative recovery is good and there is no perioperative death. The different of the time in surgery between two groups is Robots group 82 (20-320) min and thoracoscopic group 89 (35-360) min (P>0.05). The intraoperative blood loss between two groups is robot group 10 (1-100) mL and thoracoscopic group 50 (3-1,500) mL. The postoperative drainage amount within three days after surgery between two groups is robot group 215 (0-2,220) mL and thoracoscopic group 350 (50-1,810) mL. The period of bearing drainage tubes after surgery between two groups is robot group 3 (0-10) d and thoracoscopic group: 5 (1-18) d. The difference of hospital stays between two groups is robot group 7 (2-15) d and thoracoscopic group 9 (2-50) d. The hospitalization expense between two groups is robot group (18,983.6±4,461.2) RMB and thoracoscopic group (9,351.9±2,076.3) RMB (All P<0.001). CONCLUSIONS: The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach, even though its expense is higher.

Microwave ablation of the liver abutting the stomach: insulating effect of a chitosan-based thermosensitive hydrogel.

PURPOSE: Collateral thermal injury can occur as a serious complication of microwave ablation. This study aimed to assess the insulating effect of a thermosensitive, chitosan-based hydrogel during the percutaneous microwave ablation of liver tissue abutting the stomach. MATERIALS AND METHODS: Thermometry needles (R1-R4) were positioned at 5-mm intervals from a thermal source to measure in vitro the temperature differences due to the hydrogel (R1 closest to the thermal source). Subsequently, two groups of eight rabbits each were injected with 10 mL of hydrogel solution or 410 ± 95 mL of 5% saline between the liver and stomach wall. A control group of eight rabbits received no ablation protection measures. The livers were ablated with 40 W for 300 s in 24 ablation zones. The severity of thermal injury to the stomach wall was assessed histologically. RESULTS: In vitro, the mean maximum temperature difference between the R1 and R2 thermometry needles was 31.3° ± 0.1 °C. When R1 was over 60 °C, the mean temperatures at R2, R3, and R4 were 29.8° ± 0.1 °C, 18.6 ± 0.3 °C, and 18.1° ± 0.1 °C, respectively. After ablation for 300 s, the maximum temperature at R2 was 48.7° ± 0.2 °C. None of the rabbits injected with gel showed any injury after ablation; however, the other two groups showed varying degrees of thermal injury. CONCLUSION: The in situ gel protected the adjacent stomach wall from injury during percutaneous microwave ablation of liver tissue. Although the present technique appears promising, further studies are necessary prior to clinical application.

[Clinical value of acoustic radiation force impulse imaging for quantitative evaluation of degree of liver fibrosis in chronic hepatitis C patients].

OBJECTIVE: To investigate the diagnostic value of acoustic radiation force impulse (ARFI) imaging technology for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients. METHODS: One-hundred-and-eight CHC patients were examined by real-time ultrasound elastography using the Acuson S2000 ARFI instrument (Siemens Healthcare) and underwent liver biopsy for pathohistological analysis. The correlation between liver fibrosis grades determined by the two approaches was analyzed. The cut-off values for diagnosis by ARFI (S more than 2, S more than 3 and S = 4) were determined by generating a receiver operating characteristic (ROC) curve. RESULTS: The spectrum of liver stiffness detected by ARFI sonoelastography included S1 at (1.26+/-0.27) m/s (n = 36), S2 at (1.45+/-0.51) m/s (n = 31), S3 at (2.01+/-0.54) m/s (n = 27), and S4 at (2.28+/-0.82) m/s (n = 14). The ARFI values were significantly different among the four different stages of liver fibrosis (P less than 0.001). The liver stiffness detected by ARFI sonoelastography was significantly correlated with the liver fibrosis stage determined by the gold standard pathohistological analysis (Spearman's rank coefficient: 0.61, P less than 0.001). Using the ARFI technology for assessment of liver fibrosis gave areas under the ROC curve of 0.779 for S more than 2 patients, of 0.863 for S more than 3 patients, and of 0.0880 for S = 4 patients. CONCLUSION: The real-time ultrasound elastography ARFI technology can show the elasticity modulus of liver, and its data values positively correlate with the patho-histology grade of liver fibrosis in CHC patients. ARFI technology is easy to operate, non-invasive, and quantitative, and has potential clinical value for assessing liver fibrosis in CHC.

915MHz microwave ablation with high output power in in vivo porcine spleens.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of 915 MHz microwave (MW) ablation with high output power in in vivo porcine spleens. MATERIALS AND METHODS: MW ablations were performed in 9 porcine spleens with an internally cooled 915 MHz antenna. Thermocouples were placed at 5, 10, 15, 20 mm away from the antenna to measure temperatures in real-time during MW emission. The energy was applied for 10 min at high output power of 60 W, 70 W or 80 W. Gross specimens were sectioned and measured to determine ablation size. Representative areas were examined by light microscopy and electron microscopy. Coagulation sizes and temperatures were compared among the three power groups. RESULTS: Hematoxylin-eosin staining showed irreversible necrosis in the splenic coagulation area after MW ablation. As the power was increased, long-axis diameter enlarged significantly (p<.05). Short-axis diameter also tended to increase, but there were no statistical difference (p>.05). The coagulation size of long-axis and short-axis diameter with 80 W in vivo spleen ablation was 6.43+/-0.52 and 4.95+/-0.30 cm, respectively. With the increase of output power, maximum temperatures at 5, 10, 15, 20 mm from the antenna were increased accordingly (p<.05). The maximum temperature with 80 W at 5 and 20 mm from the antenna reached 146.17+/-6.65 and 72.38+/-4.23 degrees C respectively. CONCLUSION: With internally cooled antenna and high output power, 915 MHz MW ablation in the spleen could produce irreversible tissue necrosis of clinical significance. MW ablation may be used as a promising minimally invasive method for the treatment of splenic diseases.

Percutaneous microwave ablation or nephrectomy for VX-2 carcinoma in rabbit kidney.

PURPOSE: We compared the effectiveness of percutaneous microwave ablation and radical nephrectomy for implanted VX-2 carcinoma in rabbit kidneys. MATERIALS AND METHODS: VX-2 tumors were surgically implanted into the left lower pole parenchyma of 26 New Zealand White rabbit kidneys. At 12 days after implantation implanted rabbits were randomly assigned to 1 of 3 groups according to therapy type, including percutaneous microwave ablation, nephrectomy and no treatment. The anticancer effect and safety were compared among the groups. Histopathological changes in tumor tissue with time after microwave ablation were evaluated. RESULTS: The survival rate in the percutaneous microwave ablation group was significantly higher than that in the no treatment group and showed no statistically significant difference compared with that in the nephrectomy group. Serum creatinine did not increase after microwave therapy but we noted a statistically significant serum creatinine increase in the nephrectomy group. Histological analysis revealed completely coagulative necrosis of the tumor in 10 of 12 rabbits (83.3%) after microwave ablation. Two rabbits died, including 1 of peritonitis in the nephrectomy group and 1 of intestinal fistula due to heat injury in the percutaneous microwave ablation group. CONCLUSIONS: This study shows that percutaneous microwave ablation can achieve effects similar to those of radical nephrectomy. It caused no significant changes in renal function when treating implanted VX-2 renal tumors. Percutaneous microwave ablation has the potential of being a minimally invasive treatment for small renal tumors.

Focal hypoechoic tumors of Fatty liver: characterization of conventional and contrast-enhanced ultrasonography.

OBJECTIVE: The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). METHODS: Sixty-four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results. Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill-in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. CONCLUSIONS: With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.

Evaluation of focal fatty infiltration of the liver using color Doppler and contrast-enhanced sonography.

PURPOSE: To investigate the vascular characteristics of focal fatty infiltration (FFI) in the liver using color Doppler sonography (CDUS) and contrast-enhanced sonography (CEUS). METHODS: We prospectively examined 25 areas of FFI of the liver in 20 patients via conventional gray-scale sonography, CDUS, and CEUS. Cadence contrast pulse sequencing and the contrast agent SonoVue were used for CEUS examination. CEUS criteria for diagnosis of FFI were isoenhancement or hypoenhancement in the arterial phase and homogeneous isoenhancement in the portal and late phases. RESULTS: CDUS revealed a draining vein in 4 of 9 (44%) lesions in the hepatic hilum, whereas CEUS revealed a draining vein in 8 (89%) lesions. A vein was associated with the 2 lesions located at the edge of segment II on both CDUS and CEUS. Blood flow was seen on both CDUS and CEUS in the 2 lesions adjacent to the falciform ligament. In one patient, CDUS and CEUS revealed the mid-hepatic vein coursing between 2 FFIs. In the arterial phase of CEUS, the lesions were hypoenhancing in 44% (11/25), iso-enhancing in 44% (11/25), and hyperenhancing in 12% (3/25). In the portal phase and in the late vascular phase, all 25 lesions (100%) were iso-enhancing. Sensitivity of combined sonography and CDUS in the diagnosis of FFI was 44%, and overall accuracy was 81%. The sensitivity of CEUS in the diagnosis of FFI was 88%, and its overall accuracy was 96%. CONCLUSION: FFI in the porta hepatis is correlated with aberrant venous drainage. FFI around the falciform ligament may be related to divergence of the portal vein or unusual blood supply. In the arterial phase of CEUS, FFI lesions were iso-enhancing as often as they were hypoenhancing.

Ultrasound guided percutaneous microwave ablation for small renal cancer: initial experience.

PURPOSE: We evaluated the feasibility, safety and efficacy of ultrasound guided percutaneous microwave ablation for small renal cell cancers. MATERIALS AND METHODS: A total of 12 patients with a pathologically proven renal cell cancer 1.3 to 3.8 cm in diameter were treated with microwave ablation. A cooled shaft needle antenna was percutaneously inserted into the tumor under ultrasound guidance. One antenna was used for tumors 2 cm or smaller and antennae were used for tumors larger than 2 cm. One thermocouple was placed about 0.5 cm away from the tumor to monitor temperature in real time during ablation. Microwaves were emitted at 50 W for 500 seconds and prolonged as necessary to attain temperatures sufficient to ensure tumor kill. Immediate treatment efficacy was assessed by contrast enhanced ultrasound 1 day after ablation. Short-term efficacy was assessed by contrast enhanced computerized tomography and/or contrast enhanced ultrasound at 1, 3 and 6 months, and every 6 months thereafter. RESULTS: All tumors were completely ablated at a single session and no complications occurred. No residual tumor or recurrence was observed at a median followup of 11 months (range 4 to 20). The ablation zone was well defined on contrast enhanced imaging and it gradually shrank with time. CONCLUSIONS: Ultrasound guided percutaneous microwave ablation appears to be a safe and effective technique for small renal cell cancer in select patients.

Analysis of focal spared areas in fatty liver using color Doppler imaging and contrast-enhanced microvessel display sonography.

OBJECTIVE: The purpose of this study was to investigate whether focal fatty sparing (FFS) formation in the liver relates to aberrant blood flow. METHODS: Sixty-three FFSs of the liver in 52 patients were examined by color Doppler flow imaging and contrast-enhanced microvessel display sonography. The 63 FFSs included 16 FFSs in the porta hepatis, 14 FFSs around the gallbladder fossa, and 33 other FFSs. The control group included patients with a diagnosis of fatty liver but no FFSs or focal lesions near the porta hepatis. RESULTS: Fourteen of 16 FFSs in the porta hepatis showed venous blood toward those areas that were differentiated from the portal and hepatic veins. Focal fatty sparings in the hilus hepatis correlated with aberrant veins, having a statistical significance compared with the control group (P < .0001). Seven of 14 FFSs around the gallbladder fossa contained blood vessels, 5 of them veins and the remaining 2 arteries. Two FFSs were located around hemangiomas. Three FFSs were located around maldeveloped vessels. CONCLUSIONS: The blood supply to an FFS in the porta hepatis may be correlated with aberrant veins. Focal fatty sparings around the gallbladder fossa may be associated with aberrant blood flow.