Figure 1.
Flow chart of visualization of the LES and its related structures.
Figure 2.
Visualization of the anatomy of the LES on CVH2.
The LES is imaged on cross-sections from the inferior (A–C) and in 3D (D, E). (A) Starting cross-section of the LES. (B) Ending cross-section of the LES. On this section, the gastropancreatic ligament serves as the bottom margin of the LES. (C) Cross-section of the superior part of the pancreatic body. The appearance of the pancreatic body marks the disappearance of the LES; namely, the appearance of the peripancreatic space. (D) Posterointernal view of the spatial relationships of the LES to the stomach and pancreas. (E) Anteroexternal view of the LES. A: LES; B: gastric wall; C: left diaphragm; D: hepatogastric recess; E: distal esophagus; F: liver; G: upper segment of the left layer of the gastrophrenic ligament; H: lung; I: superior recess of the omental bursa; J: foramen bursae omenti majoris; K: inferior recess of the omental bursa; L: lesser omentum; M: gastropancreatic ligament; N: left retroperitoneal space; O: left adrenal gland; P: posterior gastric vein; Q: narrow space; R: left gastric vein and its branches; S: left gastric artery; T: pancreas; U: peripancreatic space; a: anterointernal leg; b: superior margin; c: diagonal line; d: posteroexternal leg; e: inferior margin.
Figure 3.
Spatial relationship between the GBA and LSFS on cross-sections from the inferior.
(A) The GBA and LSFS overlap on upper sections of CVH2. (B) The GBA and the LSFS are separated by the lower segment of the left layer of the gastrophrenic ligament on lower sections of CVH2. (C, D) The LSFS is superimposed on the GBA on cross-sections of the CVH1 and VHMA. The thin adipose layer located between the white and green lines represents the LSFS. A: GBA; B: LSFS; C: posterior gastric vein; D: gastric wall; E: diaphragm; F: lesser omentum; G: lower segment of the left layer of the gastrophrenic ligament; H: left retroperitoneal space.
Figure 4.
Manifestation of the spatial relationship between the LES and left retroperitoneal space on oblique sagittal planes.
(A, B) Visualization of the communication relationship between the left retroperitoneal space and the LES from the lateral superior view on CVH2 and CT images, respectively. The anterior renal fascia is represented as a blue line and labeled by a black arrow on CVH2 and CT images, respectively. The posterior renal fascia is represented as a green line and labeled by an arrowhead on CVH2 and CT images, respectively. A: left adrenal gland; B: LES; C: pancreas; D: esophageal hiatus; E: left diaphragm; F: retrocrural space.
Figure 5.
Visualizing the distribution of internal structures of the LES on CVH2 by transparent processing.
(A, B) Posterointernal and anteroexternal view of the LES in 3D. The left gastric artery and vein pass through the anteroinferior part of the GBA and enter the lesser omentum. The left gastric lymph nodes are situated behind the left gastric vessels in the GBA, and the left cardiac lymph nodes are situated at the fat pad of the GBA. These structures are located at the corresponding position in the LES. The trunk of the posterior gastric vein passes through the lower segment of the left layer of the gastrophrenic ligament, the GBA, the LSFS, and the GBA, near the posterior border of the LES. Finally, this trunk penetrates through the upper segment of the left layer of the gastrophrenic ligament and enters the posterior wall of the gastric fundus. Similarly, the posterior branch of the posterior gastric vein goes straight through the lower segment of the left layer of the gastrophrenic ligament at its posterior margin and reaches the gastric wall. A: GBA; B: LSFS; C: posterior gastric vein and its branches; D: lower segment of the left layer of the gastrophrenic ligament; E: left gastric artery; F: left gastric vein and its branches; G: upper segment of the left layer of the gastrophrenic ligament; H: left cardiac lymph nodes; I: left gastric lymph nodes.
Table 1.
Distribution of the internal structures of the LES.
Figure 6.
Visualizing the spatial relationship of the LES to the left retroperitoneal space on CVH2.
(A, B) Posterointernal and anteroexternal view of the spatial relationship between LES and left retroperitoneal space in 3D. The upper pole of the left retroperitoneal space overlaps with the lower portion of the LSFS, but the left retroperitoneal space is separated from the GBA by the lower segment of left layer of the gastrophrenic ligament. The left retroperitoneal space communicates with the LES across the LSFS. A: GBA; B: LSFS; C: the lower segment of left layer of the gastrophrenic ligament; D: the upper segment of left layer of the gastrophrenic ligament; E: upper portion of the left retroperitoneal space; F: left adrenal gland.
Figure 7.
Manifestation of the LES on axial CT image from the inferior.
A: LES; B: lesser omentum; C: left gastric artery; D: posterior gastric artery; E: narrow space; F: hepatic bare area; G: right adrenal gland.
Figure 8.
Presentation of the triangular-shaped LES on coronal MPR images from the front.
(A, B) Visualization of the LES on CVH2 and CT images, respectively. A: LES; B: left crura of the diaphragm; C: gastric cardia; D: gastric fundus; E: pancreas; F: splenic artery; G: splenic vein; H: root of the celiac trunk; I: right crura of the diaphragm.