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

Incidental finding of intrathoracic caudate lobe of the liver associated with an arterovenous malformation

In this case report we describe an occasional finding of intrathoracic caudate lobe protruding through the diaphragm foramen in a 73-year-old woman who came to our attention for a screening for coronary artery disease, due to the presence of cardiovascular risk. The patient had no symptoms. The computed tomography showed, a circumscribed homogeneous soft tissue mass that protruding through the aortic diaphragmatic foramen that was as isodense as the liver. Moreover was revealed an abnormal artery emerging from the celiac tripod which, through the diaphragmatic foramen, ends in an inferior pulmonary vein creating an arteriovenous malformation.

Supradiaphragmatic accessory liver tissue mimicking pleural tumour: excision by transdiaphragmatic uniportal video-assisted thoracoscopic surgery (U-VATS)

We describe a case of an extremely rare intrathoracic supradiaphragmatic accessory liver tissue that was excised via transdiaphragmatic uniportal video-assisted thoracoscopic surgery. The intrathoracic mass that was radiologically detected was found to be mimicking a pleural tumour because of its supradiaphragmatic location as well as the presence of a clear cleavage plane separating the mass and the liver completely. This, to our knowledge, is the first described case that was resected via transdiaphragmatic uniportal approach in the literature.

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.

A rare intrathoracic mass: Accessory liver lobe

A heterotopic, supradiaphragmatic liver tissue is an extremely rare entitiy. It is usually asymptomatic and is often detected incidentally. Herein, we report a female case who had coughinduced occasional back and chest pain and in whom an intrathoracic paravertebral mass was radiographically detected.

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.

Acute Trans-Diaphragmatic Herniation of the Caudate Lobe of the Liver

Diaphragmatic liver herniation is often associated with thoracoabdominal trauma. Spontaneous diaphragmatic rupture is a thoracoabdominal emergency and requires a high index of suspicion combined with high-resolution imaging studies for establishing an accurate and timely diagnosis. We present a case report of a patient who was admitted to the emergency department with severe substernal chest pain and shortness of breath who was diagnosed with spontaneous diaphragmatic rupture and caudate liver herniation. The caudate lobe was incarcerated, contributing to the patient's symptoms. A celiotomy was performed and the defect was repaired primarily.

Intrathoracic Accessory Lobe of Liver Masquerading as a Paraesophageal Mass

Heterotopic liver tissue is a relatively rare finding, which has historically been discovered incidentally during surgery or at autopsy. However, we present a 28-year-old woman who presented to the emergency department with shortness of breath and stabbing chest pain. An emergent CT angiogram of the chest was performed, which incidentally revealed a mediastinal paraesophageal mass. Subsequent endoscopic ultrasound showed a hypoechoic area that appeared to connect to the liver. A liver/spleen scan with SPECT/CT with Tc sulfur colloid demonstrated that the mass was paraesophageal heterotopic liver tissue with a connection to the orthotropic liver by a small stalk.