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Inferior phrenic artery

The inferior phrenic arteries are paired branches of the abdominal aorta, typically the first lateral branches arising just above the celiac trunk. Each artery ascends obliquely across the crura of the diaphragm, supplying the diaphragmatic surface, adrenal glands, lower esophagus, and upper abdominal structures.

The right inferior phrenic artery often arises from the aorta or celiac trunk, while the left may arise from the aorta, celiac trunk, or left gastric artery. Considerable anatomical variation exists, and accessory origins are common. Each artery divides into medial and lateral branches, which spread across the diaphragm and anastomose with superior phrenic, musculophrenic, and pericardiophrenic arteries.

The inferior phrenic arteries are clinically important because they may act as collateral vessels in hepatic tumors (especially HCC), adrenal pathology, and esophageal disease. In interventional radiology, they are common targets for transarterial chemoembolization (TACE) in liver cancer.

Synonyms

  • Arteria phrenica inferior

  • Inferior diaphragmatic artery

Function

  • Primary arterial supply to the inferior surface of the diaphragm

  • Provides branches to the adrenal glands (superior suprarenal arteries)

  • Contributes to blood supply of the esophagus, stomach, and adjacent peritoneum

  • Provides collateral circulation to the liver and mediastinum in pathological states

Branches

  • Medial branch: supplies crura of diaphragm, gives superior suprarenal arteries

  • Lateral branch: supplies lateral diaphragm, anastomoses with musculophrenic and intercostal arteries

  • Small esophageal and hepatic collateral branches may arise

MRI Appearance

T1-weighted images:

  • Appears as a thin flow void (black lumen) along the diaphragmatic crura

  • Surrounded by high-signal fat, aiding identification

T2-weighted images:

  • Vessel lumen appears as a signal void; high spatial resolution sequences help differentiate from veins

  • Perivascular edema or tumor infiltration may show hyperintensity

STIR:

  • Suppresses fat signal, highlighting the artery course in the retroperitoneum and near diaphragm

  • Useful in identifying perivascular inflammatory change

T1 Post-Gadolinium (Gd-enhanced MRI):

  • Inferior phrenic arteries enhance brightly and homogeneously

  • Enhances visualization of origin, course, and diaphragmatic branches

  • Critical for mapping tumor feeders (e.g., hepatocellular carcinoma, adrenal masses)

MRA (Magnetic Resonance Angiography):

  • Depicts the arterial origin, course, and variations

  • Useful for preoperative planning, embolization mapping, and identifying collaterals to hepatic tumors

CT Appearance

Non-contrast CT:

  • Arteries appear as small tubular soft-tissue densities, usually difficult to trace without contrast

  • Sometimes identified by surrounding fat plane along crura

CT Post-Contrast (CT Angiography):

  • Inferior phrenic arteries enhance brightly as they arise from the aorta or celiac trunk

  • Multiplanar and 3D reconstructions show origin, medial and lateral branches, and anastomoses

  • Useful for detecting anatomic variations, tumor vascular supply, aneurysms, or stenosis

  • Key in TACE planning, adrenal tumor evaluation, and diaphragmatic vascular mapping

CT images

Inferior phrenic artery anatomy CT axial image -img-00000-00000

CT images

Inferior phrenic artery anatomy CT axial image -img-00000-00000_00001