Atypical focal spared area in fatty liver: evaluation by color Doppler ultrasonography

Ultrasonography often detects focal spared areas in fatty livers. One etiology was attributed to aberrant venous drainage. On ultrasonography images the lesions usually appear wedge-shaped, irregularly shaped, or, less frequently, round. We report a rare case of an irregular, hourglass-shaped focal spared area in segment IV of the liver resulting from the coexistence of an aberrant right gastric vein and anastomoses between the aberrant vein and the portal branches as well as a portohepatic venous shunt.