Anterior hepatic grooves accompanied by Chilaiditi sign: a retrospective radiological analysis of a neglected anatomical fact

Surgical Anatomy of the Liver-Significance in Ovarian Cancer Surgery

INTRODUCTION

Ovarian cancer is the leading cause of death among all gynecological malignancies. Most patients present with an advanced stage of the disease. The routes of spread in ovarian cancer include peritoneal dissemination, direct invasion, and lymphatic or hematogenous spread, with peritoneal and lymphatic spread being the most common among them. The flow direction of the peritoneal fluid makes the right subphrenic space a target site for peritoneal metastases, and the most frequently affected anatomical area in advanced cases is the right upper quadrant. Complete cytoreduction with no macroscopically visible disease is the most important prognostic factor.

METHODS

We reviewed published clinical anatomy reports associated with surgery of the liver in cases of advanced ovarian cancer.

RESULTS

The disease could disseminate anatomical areas, where complex surgery is required-Morrison's pouch, the liver surface, or porta hepatis. The aim of the present article is to emphasize and delineate the gross anatomy of the liver and its surgical application for oncogynecologists. Moreover, the association between the gross and microscopic anatomy of the liver is discussed. Additionally, the vascular supply and variations of the liver are clearly described.

CONCLUSIONS

Oncogynecologists performing liver mobilization, diaphragmatic stripping, and porta hepatis dissection must have a thorough knowledge of liver anatomy, including morphology, variations, functional status, potential diagnostic imaging mistakes, and anatomical limits of dissection.

The volumetric measurement of developing liver atrophy in patients with Chilaiditi's sign

PURPOSE

The Chilaiditi's sign is a hepatodiaphragmatic interposition of the colon and is a rare diagnosed condition. This condition may cause a problem in liver transplantation applications which are progressively increasing in number. Although not reported in the literature, we observed that liver atrophy developed in the intestinal interposition region in patients with Chilaiditi's sign in computed tomography (CT) images. This study aimed to determine the amount of liver atrophy caused by the interposed colon, the factors that change the rate of atrophy, and the effects of this situation on the liver parenchyma.

MATERIALS AND METHODS

A total of 30,000 patients who presented to radiology department with any reason between March 2012 and March 2013 and who underwent thoracoabdominal or abdominal CT imaging were retrospectively analyzed. The volumes of the liver right lobe and lateral/medial segments of the left lobe were estimated in cm³ using Volume Viewer application in 75 cases (20 females, 55 males) in which Chilaiditi's sign was observed in CT images.

RESULTS

17-27% of the lobes affected from the colon interposition were seen to develop atrophy. The ratio of right lobe volume to total liver volume was found to be higher in patients with left lobe atrophy (74%) than right lobe atrophy (55%) (p < 0.001). Similarly, the rate of the volume of the left lobe to the total liver volume was found to be higher in cases with right lobe atrophy (45%) compared to left lobe atrophy (26%) (p < 0.001).

CONCLUSION

Hepatodiaphragmatic interposition of the colon can cause liver atrophy. This condition should especially be considered in the liver transplantation applications. Compensatory hypertrophy may develop in the unaffected liver lobe and CT is very useful for diagnostic imaging.

The liver and Chilaiditi's syndrome: Significance of hepatic surface grooves

Chilaiditi's syndrome describes a symptomatic patient with radiographic findings of interposed colon between the diaphragm and right lobe of liver. It may mimic a pneumoperitoneum on plain radiographs. We present a case in which Chilaiditis' syndrome was entertained, delaying a decision for laparotomy. This case reinforces the diagnostic difficulty associated with Chilaiditi's syndrome, and it increases awareness of an uncommon variation in the liver surface anatomy.

Accessory Grooves on the Diaphragmatic Surface of the Liver: A Cadaveric Study

INTRODUCTION

Usually liver does not possess any grooves on its diaphragmatic surface, but there are reports on the presence of grooves on this surface.

AIM

The present study was conducted to study the gross features of diaphragmatic surface of the liver and document the presence of any grooves on it and also to correlate our study with the previous studies.

MATERIALS AND METHODS

Ninety seven formalin embalmed livers stored in 10% formaldehyde were observed for the presence of grooves on diaphragmatic surface.

RESULTS

Fifteen (15.46%) livers had at least one groove on the diaphragmatic surface. Left lobe did not reveal the presence of any abnormal grooves. Presence of a single groove was observed in six (6.18%) livers; Double grooves were found in five (5.15%) livers; Triple grooves were found in three (3.09%) livers and four grooves were found in one (1.03%) liver. The deepest among all the grooves was measured 1.5 cm.

CONCLUSION

The knowledge of these grooves is of importance to radiologists and surgeons during their routine procedures.