Hepatomegaly

Published on 09/08/2015 by admin

Filed under Radiology

Last modified 09/08/2015

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 Normal liver length 8-12 cm for men, 6-10 cm for women in midclavicular line

image 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

image Palpable liver edge below costal margin
• Other signs/symptoms

image 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

image Consider triphasic CT to detect and characterize mass lesions
image Can also assist in diagnosing other etiologies
image e.g., passive hepatic congestion, steatosis
image
(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 image, extending caudally below the level of the kidney image.

image
(Right) Longitudinal ultrasound in a 38-year-old woman with nonalcoholic steatohepatitis reveals marked hepatic enlargement. Note the right hepatic lobe image extending below the level of the right kidney image as well as echogenicity greater than that of the kidney due to diffuse steatosis.
image
(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 image.

image
(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 image and IVC image 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

image Hepatic length and volume are increased
• Location

image Liver protrudes beyond costal margin
• Size

image > 15 cm measured from midhepatic line

– Normal liver length 8-12 cm for men in midclavicular line, 6-10 cm for women
• Morphology

image Focal enlargement due to mass lesion
image Diffuse enlargement due to infection, passive hepatic congestion, or infiltrative disorder

Imaging Recommendations

• Best imaging tool

image Longitudinal US or coronal triphasic CT

– Detect and characterize underlying mass
• Protocol advice

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