Citation, DOI & article data
Hepatomegaly refers to an increase in size or enlargement of the liver.
Hepatomegaly can result from a vast range of pathology including, but not limited to, the following:
- malignancy/cellular infiltrate
- acquired hepatic conditions
- acquired non-hepatic conditions
- congenital anomalies
Assessment of liver size is commonly made on ultrasound or CT, although gross hepatomegaly may be apparent on abdominal radiograph.
For the adult liver:
- midclavicular line averages 10-12.5 cm in craniocaudal length 2
- a liver that is longer than 15.5-16 cm in the midclavicular line (MCL) is considered enlarged
- average transverse diameter is 20-23 cm at the level of the upper pole of the right kidney 2
In practice, however, assessment is often subjective.
Features that support hepatomegaly include 1:
- extension of the right lobe inferior to the lower pole of the right kidney
- rounding of the hepatic inferior border
Liver volume can be assessed on cross-sectional imaging either using volumetry or by calculating an estimated liver volume from caliper measurements. The following formula was proposed for this purpose 5:
Volume = maximum cranio-caudal dimension x maximum latero-lateral dimension x maximum antero-posterior dimension x 0.31
The range of normal liver volume is however dependent on patient population and demographics, furthermore, liver volume has been shown to demonstrate a diurnal rhythm due to hydration, nutrition, and physical activity reaching its minimum value between 12-14:00 hours 6,7.
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- 2. Kennedy PA, Madding GF. Surgical anatomy of the liver. Surg. Clin. North Am. 1977;57 (2): 233-44. Pubmed citation
- 3. Dähnert W. Radiology Review Manual. (2011) ISBN: 9781609139438
- 4. Wolfgang Dähnert. Radiology Review Manual. (2011) ISBN: 9781609139438
- 5. Muggli D, Müller M, Karlo C, Fornaro J, Marincek B, Frauenfelder T. A Simple Method to Approximate Liver Size on Cross-Sectional Images Using Living Liver Models. Clin Radiol. 2009;64(7):682-9. doi:10.1016/j.crad.2009.02.013 - Pubmed
- 6. Vauthey J. Body Surface Area and Body Weight Predict Total Liver Volume in Western Adults. Liver Transpl. 2002;8(3):233-40. doi:10.1053/jlts.2002.31654 - Pubmed
- 7. Leung N, Farrant P, Peters T. Liver Volume Measurement by Ultrasonography in Normal Subjects and Alcoholic Patients. J Hepatol. 1986;2(2):157-64. doi:10.1016/s0168-8278(86)80074-5