Hepatomegaly

Last revised by Dr Bálint Botz on 19 Nov 2021

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:

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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Cases and figures

  • Case 1: hepatomegaly on abdominal radiograph
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  • Case 2
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  • Case 3: CML with hepatosplenomegaly
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  • Case 4: due to metastases
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  • Case 5: metastases displacing bowel inferiorly
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  • Case 6: myelofibrosis
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  • Case 7
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