Normal liver length 8-12 cm for men, 6-10 cm for women in midclavicular line
But consider other dimensions and volume of liver
• Best imaging tool: Longitudinal US or coronal CT or MR
TOP DIFFERENTIAL DIAGNOSES
• Riedel lobe
• Caudate hypertrophy in Budd-Chiari or primary sclerosing cholangitis
• Liver displacement by COPD
• Lobar regeneration after major liver resection
CLINICAL ISSUES
• Most common signs/symptoms
Palpable liver edge below costal margin
• Other signs/symptoms
Jaundice, RUQ pain, fever, abnormal liver function tests
• Prognosis: Benign outcome to fulminant liver failure
• Biopsy often required for definitive diagnosis
DIAGNOSTIC CHECKLIST
• Hepatitis, steatosis, passive congestion, and diffuse tumor are most common causes
• Image interpretation pearls
Consider triphasic CT to detect and characterize mass lesions
Can also assist in diagnosing other etiologies
e.g., passive hepatic congestion, steatosis
(Left) Longitudinal ultrasound in a 44-year-old man with a history of hepatitis B infection shows marked enlargement of the right lobe of the liver , extending caudally below the level of the kidney .
(Right) Longitudinal ultrasound in a 38-year-old woman with nonalcoholic steatohepatitis reveals marked hepatic enlargement. Note the right hepatic lobe extending below the level of the right kidney as well as echogenicity greater than that of the kidney due to diffuse steatosis.
(Left) Coronal CECT reformation of a 52-year-old man with metastatic colon cancer shows marked enlargement of the liver with diffuse metastases throughout the right lobe .
(Right) Venous phase coronal CECT of a 27-year-old woman with leukemia and new onset of RUQ pain shows an enlarged and heterogeneous liver with distended hepatic veins and IVC due to passive congestion of the liver. Drug toxicity accounted for the cardiac dysfunction.
TERMINOLOGY
Definitions
• Enlargement of liver due to underlying pathologic process
IMAGING
General Features
• Best diagnostic clue
Hepatic length and volume are increased
• Location
Liver protrudes beyond costal margin
• Size
> 15 cm measured from midhepatic line
– Normal liver length 8-12 cm for men in midclavicular line, 6-10 cm for women
• Morphology
Focal enlargement due to mass lesion
Diffuse enlargement due to infection, passive hepatic congestion, or infiltrative disorder
Imaging Recommendations
• Best imaging tool
Longitudinal US or coronal triphasic CT
– Detect and characterize underlying mass
• Protocol advice
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, extending caudally below the level of the kidney 
.
extending below the level of the right kidney 
as well as echogenicity greater than that of the kidney due to diffuse steatosis.
.
and IVC 
due to passive congestion of the liver. Drug toxicity accounted for the cardiac dysfunction.
