Supradiaphragmatic Heterotopic Liver Presenting as a Pleural Mass: A Case Report

Incidental finding of heterotopic supradiaphragmatic liver

Here we describe a case of heterotopic, supradiaphragmatic liver in a 65-year-old woman who was referred for investigation of a soft tissue gallbladder mass. Contrast-enhanced magnetic resonance imaging revealed adenomyomatosis of the gallbladder and supradiaphragmatic accessory liver tissue. This is a remarkably rare normal variant.

Caval foramen hernia in a dog: Preoperative diagnosis and surgical treatment

A 13-year-old, 5.6-kg castrated-male Maltese was presented for reverse sneezing. A dome-shaped round mass abutting diaphragm was incidentally found ventral to caudal vena cava, which had the same echogenicity and density as that of the liver during ultrasonography and computed tomography, showing isoattenuation with a contrast study. Vascular distribution was identified throughout the mass. A caval foramen hernia (CFH) was diagnosed tentatively, followed by a herniorrhaphy and splenectomy of the chronically congested spleen. The patient had been doing well for 5-month postoperative but died because of aspiration pneumonia. CFH is an extremely rare condition, requiring surgery due to compression of the vena cava. It should be considered as a differential diagnosis when intrathoracic, mass-like lesions are identified near the diaphragm.

Incidental finding of a supradiaphragmatic caudate lobe on cross-sectional imaging: An exceedingly rare entity

Intrathoracic accessory lobes of the liver are exceedingly rare and usually found incidentally in asymptomatic patients. Its diagnosis poses a real challenge for radiologists due to its rarity, location and rounded solid mass appearance. Herein, we describe the case of a supradiaphragmatic caudate lobe of the liver in a 43-year-old African American woman presenting to the hospital for evaluation of an inferior vena cava (IVC) thrombus with CT. Final diagnosis was achieved by MRI using intravenous contrast material, showing a 4.7 cm by 2.7 cm oval shaped mass, with similar signal intensity to the main liver on all sequences. Appropriate diagnosis of this intrathoracic mass is important to negate the need for unnecessary procedures and set a proper follow up after clinical diagnosis.

Accessory liver within the thoracic cavity

Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.

Intrathoracic caudate lobe of the liver: A case report and literature review

Heterotopic supradiaphragmatic livers are rare. A total of 23 cases of primary supradiaphragmatic livers have been reported in the literature. The clinical presentations of heterotopic supradiaphragmatic liver are variable. The simultaneous detection of intrathoracic accessory liver and pulmonary sequestration is extremely rare, and only one case has previously been reported. It is difficult to make a correct diagnosis preoperatively. We presented a 53-year-old woman with complaints of an intermittent, productive cough and dyspnea for two months that was refractory to medical treatment. She had no previous history of trauma or surgery. A chest radiograph only showed a widening of the mediastinum. Contrast-enhanced computed tomography of the chest revealed a well-circumscribed homogenous soft-tissue mass, approximately 4.35 cm × 2.5 cm × 6.14 cm in size, protruding through the right diaphragmatic crura to the right pleural cavity, attached to the inferior vena cava, esophagus and liver. There was no conclusive diagnosis before surgery. After the operation, we discovered that this patient was the first case of a supradiaphragmatic heterotopic liver, which passed through the inferior vena cava foramen and was coincidentally combined with an intralobar pulmonary sequestration that was found intraoperatively. We discussed its successful management with surgical resection via a thoracic approach and reviewed the published literature.