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Nakamata A, Matsuki M, Watanabe Y, Kobayashi R, Fujii N, Kunitomo N, Otake Y, Fujii H, Hamamoto K, Mori H. Imaging Features of Uncommon Entities That Manifest with Torsion. Radiographics 2024; 44:e230101. [PMID: 38870044 DOI: 10.1148/rg.230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Torsion is the twisting of an object along the axis, and various structures (organs and tumors) in the body can twist. Torsion causes initial lymphatic and venous outflow obstruction, leading to congestive edema, enlargement, venous hemorrhagic infarction, and surrounding edema. It can also cause subsequent arterial obstruction depending on the degree of torsion, leading to ischemia, infarction, necrosis, gangrene, and surrounding inflammation. Therefore, in several cases of torsion, immediate surgical intervention is required to improve blood flow and prevent serious complications. Clinical manifestations of torsion are often nonspecific and can affect individuals of varying ages and sex. Imaging plays an important role in the early diagnosis and management of torsion. Multiple imaging modalities, including US, radiography, CT, and MRI, are used to evaluate torsion, and each modality has its specific characteristics. The imaging findings reflect the pathophysiologic mechanism: a twisted pedicle (whirlpool sign), enlargement of the torsed structures, reduced blood flow, internal heterogeneity, and surrounding reactive changes. The whirlpool sign is a definitive characteristic of torsion. In some cases, despite poor internal enhancement, capsular enhancement is observed on contrast-enhanced CT and MR images and is considered to be associated with preserved capsular arterial flow or capsular neovascularization due to inflammation. Radiologists should be familiar with the pathophysiologic mechanisms, clinical characteristics, and imaging characteristics of torsion in various structures in the body. Since other articles about common organ torsions already exist, the authors of this article focus on the uncommon entities that manifest with torsion. ©RSNA, 2024.
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Affiliation(s)
- Akihiro Nakamata
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Mitsuru Matsuki
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Yuriko Watanabe
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Ryoma Kobayashi
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Nana Fujii
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Naoki Kunitomo
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Yuko Otake
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Hiroyuki Fujii
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Kohei Hamamoto
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Harushi Mori
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
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Krause T, Cholewa D, Liniger B, Berger S, Milosevic M. Torsion of an Accessory Liver Lobe in a Newborn. European J Pediatr Surg Rep 2024; 12:e7-e10. [PMID: 38230267 PMCID: PMC10789581 DOI: 10.1055/s-0043-1778663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/10/2023] [Indexed: 01/18/2024] Open
Abstract
Accessory liver lobes are rare. We present the rare case of torsion of an accessory liver lobe in a neonate. A 13-day-old newborn presented with failure to thrive and hematemesis without fever. The initial workup with sonography, magnetic resonance imaging, and upper gastrointestinal study was suspicious of a duplication cyst, most likely in the posterior wall of the stomach. Laboratory and radiological findings were not suggesting a choledochal cyst. We performed a laparotomy with resection of the 3.2 × 2.1 × 1.1 cm mass. Intraoperatively, the cystic formation extended from of the liver bed up to the lesser curvature of the stomach. The mass was attached to the left liver lobe with fibrous bands. Histopathology revealed necrotic liver parenchyma with patent viable biliary ducts, indicative of an accessory liver lobe that underwent torsion in the perinatal period. The postoperative course and follow-up (6 months so far) were uneventful. To our knowledge, this is the youngest described patient in the literature with an accessory liver lobe torsion and the second case report concerning this entity in a neonate. It presents an extremely rare differential diagnosis in symptomatic neonates with a cystic mass in the upper abdomen.
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Affiliation(s)
- Tobias Krause
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Dietmar Cholewa
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Benjamin Liniger
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Steffen Berger
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Milan Milosevic
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
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Xiong X, Lou Y, Zhou T, Zheng Z, Liu Y, Liu R, Zhang K, Gong Y, Tang C, Jin Z. Case report: A case of giant accessory hepatic lobe torsion combined with left hepatic vein branch thrombosis in a child. Front Pediatr 2022; 10:970876. [PMID: 36225337 PMCID: PMC9549201 DOI: 10.3389/fped.2022.970876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
The accessory hepatic lobe (AHL) is a rare congenital malformation of the hepatic tissue, among which the giant AHL is the rarest in children. Patients without complications are usually asymptomatic, and most auxiliary examinations cannot provide a definitive preoperative diagnosis. Surgical procedure is the only recommended management for patients who suffered from the complications of AHL. We report the case of a rare pediatric giant AHL torsion combined with left hepatic vein branch thrombosis which was successfully treated by laparoscopic lobectomy followed by excision of AHL.
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Affiliation(s)
- Xiangang Xiong
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Yonghua Lou
- School of Preclinical Medicine, Zunyi Medical University, Zunyi, China
| | - Teng Zhou
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Zebing Zheng
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Yuanmei Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Rui Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Kaizhi Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Yuan Gong
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Chengyan Tang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Zhu Jin
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
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