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. She has never had pain like this in the past. Also reports several episodes of non-bloody non-bilious emesis.

Patient Data

Age: 70 years
Gender: Female

There is a 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 a small amount of perihepatic fluid and fat stranding. The vessels are normal.

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

CT guided liver lesion biopsy.

Case Discussion

The non-specific radiological findings lead to a CT guided liver lesion core biopsy with pathology results of infarcted liver tissue. She 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 of right liver lobe resection:

Liver tissue with ischemic changes and associated with 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.

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