A right hepatic artery forming a Moynihan’s hump with a hepatic inflammatory pseudotumor: a case description

Sep 30, 2026

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Letter to the Editor describing a surgical case involving an atypically oriented right hepatic artery encountered during hepatic hilar vessel dissection. A 76-year-old man presented with intermittent fever, chills, impaired liver function, elevated inflammatory markers, and a left-lobe cystic mass with bile duct dilation on contrast-enhanced imaging, initially suspected as biliary malignancy. Laparoscopic radical resection for presumed intrahepatic cholangiocarcinoma proceeded, with histopathology ultimately diagnosing an inflammatory pseudotumor associated with IgG4 cholangitis and a Moynihan’s hump arterial configuration.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Introduction

Case presentation

Consent and ethical approval

Patient presentation and diagnostic workup

Surgical procedure and intraoperative findings

Laboratory findings

Letter to the Editor A right hepatic artery forming a Moynihan’s hump with a hepatic inflammatory pseudotumor: a case description Heyue Zhang^, Wei Wu, Yan Zhang, Jin Xu^ First General Surgery Department, The Sixth People’s Hospital of Shenyang, Shenyang, China Correspondence to: Jin Xu, MD. First General Surgery Department, The Sixth People’s Hospital of Shenyang, No. 85 Heping Nan Street, Shenyang 110006, [China. Email: xujinwang@163.com](China. Email: xujinwang@163.com). Submitted Feb 16, 2025. Accepted for publication Oct 31, 2025. Published online Dec 31, 2025. doi: 10.21037/qims-2025-385 View this article at: [https://dx.doi.org/10.21037/qims-2025-385](https://dx.doi.org/10.21037/qims-2025-385) Introduction Hepatic hilar vessel dissection is a critical procedure in liver surgery. Hepatic artery (HA) direction anomalies are commonly overlooked risk factors that can significantly affect patient outcomes . We admitted a patient with a primary diagnosis of a liver cyst accompanied by fever. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 10-cm cystic mass in the left hepatic lobe, which was suspected to be a biliary duct malignancy. Laparoscopic radical resection of intrahepatic cholangiocarcinoma (ICC) was performed. Intraoperatively, during the dissection of the hepatic tissue, an unusually oriented right hepatic artery (RHA) was encountered. After meticulous examination, the surgery was successfully completed. The patient had a favorable postoperative recovery. Following the histopathological examination, the patient was diagnosed with an inflammatory pseudotumor (IPT) associated with immunoglobulin G4 (IgG4) cholangitis. Case presentation All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from the patient for the publication of this article and accompanying images. A copy of the written consent is available for review by the editorial office of this journal. A 76-year-old male patient presented with intermittent fever and chills, and a body temperature reaching up to 39.0 ℃ . He reported that he first experienced paroxysmal pain in the upper abdomen some 10 months ago. Despite anti-inflammatory treatment, his symptoms were not significantly alleviated. An ultrasound examination conducted at another hospital suggested the presence of a hepatic cyst. In pursuit of further treatment, the patient sought consultation at our hospital’s outpatient department, and was admitted with a provisional diagnosis of a liver cyst and fever. Upon admission, the patient underwent a comprehensive set of laboratory and imaging examinations. The laboratory data revealed impaired liver function, elevated inflammatory markers, and a carbohydrate antigen 19-9 (CA19-9) level of 123 U/mL. All the other laboratory parameters fell within the normal range ( Table 1) . Contrast-enhanced MRI and CT of the liver revealed a cystic mass in the left lobe, with associated dilation of the left hepatic bile duct, which was more pronounced post-contrast administration, suggesting a bile duct malignancy (Figure 1) . Following symptomatic treatment, which included anti-inflammatory and hepatoprotective measures, the patient’s laboratory indicators improved. The preoperative diagnosis was a hepatic cystic mass with consideration of ICC, and a differential diagnosis that included intrahepatic bile duct cystadenocarcinoma. The patient underwent laparoscopic surgery nine ^ ORCID: Heyue Zhang, 0000-0002-2746-0846; Jin Xu, 0000-0003-0832-5793. © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):102 | [https://dx.doi.org/10.21037/qims-2025-385](https://dx.doi.org/10.21037/qims-2025-385) Page 2 of 6 Zhang et al. Hepatic IPT & RHA forming a Moynihan’s hump Table 1 Patient’s admission an

FAQs

What was the initial clinical suspicion before surgery?

Imaging and clinical data suggested a left-lobe hepatic cystic mass with bile duct dilation, leading to consideration of biliary malignancy such as intrahepatic cholangiocarcinoma and related differential diagnoses.

What unusual vascular anatomy was found during the operation?

During dissection, an unusually oriented right hepatic artery was identified, coursing in an aberrant pattern consistent with a Moynihan’s hump configuration.

What was the final diagnosis after histopathology?

Histopathological examination diagnosed an inflammatory pseudotumor associated with immunoglobulin G4 (IgG4) cholangitis.

Sep 30, 2026

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