Left sided portal vein anomalies are exceedingly rare but with the advent of complex surgical and interventional radiologic liver procedures, knowledge of major and subtle portal vein variations is becoming essential to ensure patient safety and treatment success. We present a purely left sided portal vein variant shown as a left sided common trunk that gives off all the major portal sectoral branches.

A 30 year old female who previously underwent open chlecystectomy presented with anemia postoperatively and was detected ultrasonographically to have a variant portal vein anatomy that was confirmed by triphasic CT scan with 3D reconstruction. Ultrasound and CT revealed the absence of a normal right portal vein with the left portal vein serving as the main portal trunk that would eventually give rise to all the major sectoral branches of the right and left portal veins.

Familiarity with portal vein anomalies is essential particularly in liver transplant surgery, interventional radiology and major hepatic resections. Knowledge of these variations would help prevent or minimize treatment complications.