Hepatic segmental torsion

Case contributed by Dr Eric F Greif

Presentation

Right sided dull abdominal pain for the last two days. No aggravating or relieving factors. Patient has never had pain like this in the past. Also reports several episodes of nonbloody nonbillious emesis.

Patient Data

Age: 70
Gender: Female
CT

There is well-defined homogeneous hypodense lesion involving the inferior posterior/tip of the right hepatic lobe. This lesion measures soft tissue density with no significant enhancement. There is small amount of perihepatic fluid and fat stranding. The vascular appears patent.

Annotated image

There is a "swirl" or a "twist-like" appearance of the hepatic parenchyma (yellow arrow), just above/adjacent to the hypodense lesion.

CT

CT guided liver lesion biopsy.

Case Discussion

The nonspecific radiological findings lead to an IR CT guided liver lesion core biopsy with pathology results of infarcted liver tissue. Patient was then taken to surgery and a laparoscopic partial hepatectomy  procedure was performed, which found a twisted segment 5 of the liver, likely an infarcted segment. Pathology results post surgery:  LIVER, RIGHT LOBE, SEGMENTAL RESECTION: Liver tissue with ischemic changes and associated recent hemorrhage. There is no evidence of a neoplastic process. The findings are compatible with hepatic infarct.

Radiologic, surgical and pathological findings are constant for liver segmental torsion with segmental hepatic infarct.

 

 

PlayAdd to Share

Case information

rID: 53789
Case created: 6th Jun 2017
Last edited: 7th Jun 2017
Tags: rare, torsion
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.