In some cases, focal fatty change of the liver parenchyma has been attributed to local systemic venous inflow replacing the portal venous supply. However, no reports of focal fatty change in the dorsal portion of segment IV of the liver caused by direct inflow of an aberrant pancreaticoduodenal vein (APDV) through the parabiliary venous system (PVS) are available. We report a 60-year-old woman with focal fatty change in segment IV of the liver which occurred after gastrectomy with APDV shown on CT performed during selective gastroduodenal arteriography.