Figure 9. Paraumbilical vein. Also present: kidney.

A 78-year-old male with cirrhosis, portal hypertension, and intrahepatic cholangiocarcinoma with mixed a hepatocellular carcinoma component and no prior radioembolization was injected with ^99mTc-MAA via right groin access into both right and left hepatic arteries. He had prior preventative embolization occlusion of a falciform artery arising from the left hepatic artery, and was imaged 108 minutes after injection. Calculated lung shunt fraction was 3%. He underwent ⁹⁰Y-radioembolization 27 days later without complication.

Axial, coronal, and MIP SPECT (Row A), axial and coronal fused SPECT/CT (Row B), axial and coronal CT (Row C), and anterior planar (D) images demonstrate radiotracer uptake within a recanalized paraumbilical vein, extending along the inferior surface of the liver and continuing in the anterior right portion of the abdomen. This finding becomes apparent in cases of cirrhosis with portal hypertension, which are not uncommon during hepatic artery perfusion scintigraphy, given the associated prevalence of hepatocellular carcinoma within this patient population. Uptake was also seen in the kidney.