Absence of the left lobe of the liver: US and CT appearance

The Role of Pathological Examination of the Liver in Medicolegal Autopsy: A Tertiary Care Center Study From North India

BACKGROUND

The pathological examination of a medicolegal autopsy is a great learning opportunity for a pathologist as well as for a forensic expert, where the cause of death remains unknown. Liver disease epidemiology differs from one geographic area to another.

MATERIAL AND METHODS

This was a prospective observational study with 100 medicolegal autopsy cases over a one-year period conducted in the Department of Forensic Medicine and Toxicology (FMT) and Pathology. Representative tissue from the liver was collected in 10% neutral buffered formalin and sent for histopathological examination.

RESULTS

The mean age of the cases was 41.98 ± 15.39 years, and ages ranged from 20 to 90 years with male preponderance. The most common histopathology and gross findings noted were mild to moderate chronic hepatitis (CH) (54%) and fatty change (36%), respectively. There was a significant association (p ≤ 0.05) between histopathology and gross findings, cause, and manner of death.

CONCLUSION

Gross and histopathological examination of the liver in a medicolegal autopsy has a significant role in ascertaining the cause and manner of death.

Agenesis of hepatic lobes in a dog

Agenesis of a hepatic lobe is an extremely rare congenital anomaly and only one dog have been reported in veterinary literature. We encountered a dog with this anomaly diagnosed by Computed tomography (CT) and portography. A two-year-old, 6.9-kg female Shih tzu dog was presented with vomiting and anorexia. The dog had no history of abdominal surgery or trauma. Biochemical analysis showed elevated plasmatic liver enzymes. CT revealed the absence of the liver parenchyma and vascular system of the left lobe, quadrate lobe and papillary process of the caudate lobe. A portosystemic shunt was also observed. The liver parenchyma and vascular system of these lobes were not detected under digital subtraction angiography during laparotomy. Furthermore, the liver parenchyma and vascular system of these lobes were not detected even when the remaining liver volume increased two months after treating the shunt vessel. CT proved itself a good option for antemortally diagnosis of hepatic agenesis in a dog.

MRI rare finding: Absence of the left liver lobe

We report a rare case of left liver lobe absence in an 80-year-old male patient discovered during an MRI scan. The main imaging features of this condition are briefly reviewed, together with its pathogenesis and the most common associations and differential diagnoses.

Agenesis of the left hepatic lobe undergoing laparoscopic hepatectomy for hepatocellular carcinoma: a case report

Background

Agenesis of the left hepatic lobe is a rare anomaly. It is defined as the absence of liver tissue to the left of the gallbladder fossa. Additionally, agenesis of the left hepatic lobe accompanied by hepatocellular carcinoma is quite rare. We experienced the case of a patient with agenesis of the left hepatic lobe, undergoing laparoscopic hepatectomy for HCC.

Case presentation

A 79-year-old man was referred to our department with epigastralgia. Abdominal computed tomography revealed agenesis of the left hepatic lobe, accompanied by hepatocellular carcinoma in segments 7 and 8. He underwent laparoscopic partial hepatectomy of segments 7 and 8. The operative findings revealed complete agenesis of the liver to the left of the falciform ligament. The patient had a favorable clinical course without liver dysfunction or any complications.

Conclusions

We experienced a case with agenesis of the left hepatic lobe undergoing laparoscopic hepatectomy for HCC. Awareness of such anomaly is important for surgeons to avoid postoperative complications.

MR Imaging of Anomalous Lobes of the Liver

Four patients with anomalous lobes of the liver were observed at MR imaging. In one patient the anterior segment of the right hepatic lobe was absent and in 3 patients the left hepatic lobe was anomalous. The hepatic vasculature supporting the information of the anomalous hepatic lobes was well observed in all patients.

Hypoplastic left lobe of liver with accessory caudate lobe

During routine dissection, a liver from a cadaver of a female aged 50 years was observed to have hypoplastic left lobe, and on posterior surface an accessory caudate lobe was present to the left of main caudate lobe. It was separated by well-defined fissure from caudate lobe. The fissure for ligamentum venosum was present to the left of accessory caudate lobe. Porta hepatis was present below the new lobe. Prominent papillary process continued with caudate process which in turn is fused with right lobe of the liver. These developmental anomalies of liver may cause confusion during procedures like biopsy, transplantation, and lobectomies. This knowledge may be of immense use to clinicians for the diagnosis and management of hepatic diseases, morphologists and anatomists for new variant, and to embryologists for new developmental defect.

Gastric volvulus associated with agenesis of the left lobe of the liver in a child: a case treated by laparoscopic gastropexy

Association of gastric volvulus with agenesis of the left lobe of the liver is very rare and mostly reported in adults. We report a case of gastric volvulus associated with agenesis of the left lobe of the liver in a child, which was successfully treated by laparoscopic gastropexy.

Congenital and acquired anomalies of the portal venous system

Knowledge of the normal anatomy, most frequent variants, and congenital and acquired anomalies of the portal venous system is of great importance for liver surgery and interventional procedures such as creation of transjugular intrahepatic portosystemic shunts. Radiologic studies of the portal venous system include color Doppler ultrasonography (US), computed tomography (CT), magnetic resonance imaging, and arterial or direct portography. Among the most common branching variants of the portal vein are trifurcation, right anterior portal branch arising from the left portal vein, and right posterior portal branch arising from the main portal vein. Agenesis of the right or left portal vein is the most frequently reported congenital anomaly. Venous collateral vessels due to portal hypertension and cavernous transformation of the portal vein are best evaluated with cross-sectional imaging. Intrahepatic portosystemic, arterioportal, and arteriosystemic fistulas and associated perfusion anomalies have characteristic features at dual-phase helical CT. Color Doppler US is the single most useful tool for demonstration of aneurysms of the portal venous system and bland or neoplastic portal vein thrombosis. CT is also the best means of evaluating gas in the portal venous system, which is no longer an ominous sign and must be differentiated from aerobilia.

Variations in liver-colon anatomic relationship: relevance to interventional radiology

PURPOSE

To determine the prevalence of significant variations in liver-colon anatomy in an unselected patient population and evaluate the potential effect of these variations on liver-related interventional procedures.

PATIENTS AND METHODS

All abdominal computed tomographic (CT) scans were reviewed prospectively over a 4-month period. Cases that revealed variant hepatocolic anatomy were selected and analyzed for the position of the colon, gallbladder, and duodenum; liver morphology; and the anatomic relations of the right portal vein.

RESULTS

Seventeen (3.3%) of 517 abdominal CT scans demonstrated variant hepatocolic anatomic relations. In seven cases, liver lobar morphology was normal, but the colon was interposed between the chest wall and the liver. The remaining 10 cases were characterized by hypoplasia or aplasia of one or both segments of the left lobe. In these cases the right portal vein was anteriorly exposed and was close to the gallbladder and transverse colon. In all 17 cases it was qualitatively judged that technical modifications might be needed in the performance of various interventional procedures, including percutaneous biliary drainage, biopsies, and transjugular intrahepatic portosystemic shunt creation.

CONCLUSION

Variations in liver-colon anatomic relations in isolation or secondary to hepatic developmental anomalies may have a significant potential impact on the performance of various fluoroscopically guided hepatobiliary interventional procedures.

Anomalous right lobe of the liver: CT appearance

We report five cases of anomalous right lobe of the liver diagnosed by computed tomography (CT). There were three men and two women, with an average age of 67 years. The right lobe was deformed and decreased in size in all patients. Hypertrophy of the left lobe was present in all patients.