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Congenital Left Lobe Megaly of Liver Resembling Splenic Pathology

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Congenital Left Lobe Megaly of Liver Resembling Splenic Pathology Splenosis. Indian Journal of Surgery. 2019 Dec 1;81(6):602- Dec 2019 Surgery. of Journal Indian Splenosis. liver. Journal of the Anatomical Society of India. 2018 Aug 1;67:S73. Aug 2018 India. of Society Anatomical the of Journal liver. 11. Solav SV, Patil AM, Savale SV. Radionuclide Liver-Spleen Scan to Detect Detect to Scan Liver-Spleen Radionuclide SV. Savale AM, Patil SV, Solav 11. 3. Joshi SS, Valimbe N, Joshi SD. Morphological variations of left lobe of of lobe left of variations Morphological SD. Joshi N, Valimbe SS, 3. Joshi patients. Journal of hepatology. 2003 Sep 1;39(3):326-32. Sep 2003 hepatology. of Journal patients. MDText. com, Inc.. com, MDText. tomography (SPECT) for assessment of hepatic function in cirrhotic cirrhotic in function hepatic of assessment for (SPECT) tomography GnRH and gonadotropin secretion. In Endotext [Internet] 2018 Jun 19. 19. Jun 2018 [Internet] Endotext In secretion. gonadotropin and GnRH Quantitative liver-spleen scan using single photon emission computerized computerized emission photon single using scan liver-spleen Quantitative 2. Marques P, Skorupskaite K, George JT, Anderson RA. Physiology of of Physiology RA. Anderson JT, George K, Skorupskaite P, 2. Marques 10. Zuckerman E, Slobodin G, Sabo E, Yeshurun D, Naschitz JE, Groshar D. D. Groshar JE, Naschitz D, Yeshurun E, Sabo G, Slobodin E, Zuckerman 10. Toronto: Elsevier Churchill Livingstone 2008p. 1207-8. 2008p. Livingstone Churchill Elsevier Toronto: Jan;19(1):3. Edinburg, London, New York, Oxford, Philadelphia, St. Louis, Sydney, Sydney, Louis, St. Philadelphia, Oxford, York, New London, Edinburg, medicine: official publication, Society of Nuclear Medicine. 1978 1978 Medicine. Nuclear of Society publication, official medicine: 1. Standring S. Gray’s Anatomy. Pelvic girdle and lower limb, 40th edn. edn. 40th limb, lower and girdle Pelvic Anatomy. Gray’s S. 1. Standring of pediatric splenic trauma treated without surgery. Journal of nuclear nuclear of Journal surgery. without treated trauma splenic pediatric of 9. Fischer KC, Eraklis A, Rossello P, Treves S. Scintigraphy in the followup followup the in Scintigraphy S. Treves P, Rossello A, Eraklis KC, 9. Fischer REFERENCES African health sciences. 2001;1(1):23-5. sciences. health African regarding their diagnosis of hepatic & splenic pathologies. splenic & hepatic of diagnosis their regarding 8. Makoba IG. Splenic injury following trauma: The role of ultrasonography. ultrasonography. of role The trauma: following injury Splenic IG. 8. Makoba Medicine. 1996 Dec;89(12):702-4. 1996 Medicine. made it more popular &reliable for the physicians physicians the for &reliable popular more it made misdiagnosed as splenic haematoma. Journal of the Royal Society of of Society Royal the of Journal haematoma. splenic as misdiagnosed correlation have increased the specificity of this scan& scan& this of specificity the increased have correlation 7. Dunlop DG, Evans RM. Congenital abnormality of the liver initially initially liver the of abnormality Congenital RM. Evans DG, 7. Dunlop physicians to avoid misinterpretations.SPECT-CT misinterpretations.SPECT-CT avoid to physicians Mar 1;17(1):12-5. Mar ultrasound detection of focal liver lesion. Medical Ultrasonography. 2015 2015 Ultrasonography. Medical lesion. liver focal of detection ultrasound ultrasonogram, this nuclear medicine test can guide the the guide can test medicine nuclear this ultrasonogram, variation of the liver with elongated left lobe may be a trap forthe forthe trap a be may lobe left elongated with liver the of variation clinical aspect. When the results are inconclusive in in inconclusive are results the When aspect. clinical 6. Wu S, Tu R, Liu G, Nan R, Guan Y, Zheng E, Zhao Y. Anatomical Anatomical Y. Zhao E, Zheng Y, Guan R, Nan G, Liu R, Tu S, 6. Wu SPECT-CT scan may be an investigation of choice in this this in choice of investigation an be may scan SPECT-CT 1;151(6):451-5. as splenic infarction. Liver-spleen scintigraphyspecially scintigraphyspecially Liver-spleen infarction. splenic as description and clinical implications. Journal of visceral surgery. 2014 Dec Dec 2014 surgery. visceral of Journal implications. clinical and description Compagnon P, Laurent A, Azoulay D. Accessory liver lobes: anatomical anatomical lobes: liver Accessory D. Azoulay A, Laurent P, Compagnon perisplenic collection or sometimes may be misdiagnosed misdiagnosed be may sometimes or collection perisplenic 5. Glenisson M, Salloum C, Lim C, Lacaze L, Malek A, Enriquez A, A, Enriquez A, Malek L, Lacaze C, Lim C, Salloum M, 5. Glenisson which may often mimic as splenic trauma, sub capsular or or capsular sub trauma, splenic as mimic often may which medicine. 2014 Jul 1;32(7):814-e3. Jul 2014 medicine. Left lobe megaly of liver is a rare congenital anomaly anomaly congenital rare a is liver of megaly lobe Left sonography for trauma exam. The American journal of emergency emergency of journal American The exam. trauma for sonography a subcapsular hematoma of the spleen on the focused assessment with with assessment focused the on spleen the of hematoma subcapsular a CONCLUSION 4. Jones R, Tabbut M, Gramer D. Elongated left lobe of the liver mimicking mimicking liver the of lobe left Elongated D. Gramer M, Tabbut R, 4. Jones CASE REPORT A liver-spleen scan was asked for this patient at the most important technique and removed diagnostic dilemma. hepatic buds. Left lobe, caudate lobe and quadrate lobe kinds of morphological variations of left lobe found in the scintigraphy division of NINMAS. Static images of the literatures including hypertrophied/ elongated left lobe, Congenital left lobe megaly of liver resembling Transaxial, coronal & sagittal SPECT-CT images develop from left hepatic bud and right lobe develops liver & spleen were obtained in anterior, posterior & demonstrated an unusually enlarged liver occupying the part from right hepatic bud. At three months of gestation, hypoplasia of left lobe and presence of fissures. Some lateral positions, 30 minutes after IV administration of splenic pathology: a diagnostic dilemma confirmed of right hypochondrium, epigastrium andlefthypochondrium. the liver almost fills the abdominal cavity and its left authors classified left lobe as a) extremely long left lobe; 3.5 mCi of 99m-Tc Sn colloid. Transaxial, coronal & Size of the spleen was normal but markedly compressed and lobe is nearly as large as its right. When b) too flat like pancake; c) ligular prolongation (spatular); sagittal SPECT-CT images were obtained reconstructed. bySPECT-CT of liver-spleen scan shifted posteriorly by the hugely enlarged left lobe of liver. haematopoietic activity of the liver is assumed by the d) enlargement of left lobe (3). 1 1 1 Planar images revealed hepatomegaly with elongated left Both liver and spleen concentrated radio-colloid uniformly. spleen and bone marrow, the left lobe undergoes some An elongated left lobe of the liver (also known as Beaver Puja Bhattacharjee ,Tapati Mandal , Sharmin Quddus , Pupree Mutsuddi, Papia Akhter, Md. Azharul Islam, Md. Ismail, Abu Bakker Siddique, Reajul Islam, Jasmine Ara Haque lobe and normal sized spleen. There was no evidence of There was a pocket between the liver & spleen occupied by degeneration and becomes smaller than the right (1, 2). tail liver) is defined when the left lobe of the liver extends colloid shift (Figure 2). SPECT-CT aided the diagnosis as the bowel loops and no evidence of splenic hematoma (Figure: 3). Anatomical dysmorphosis is not common for liver. beyond the stomach to the left and / or reaches the superior National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka, Bangladesh Correspondence Address: : Dr.Puja Bhattacharjee, Medical Officer, Scintigraphy Division, NINMAS, Block-D, BSMMU campus, haka-1000, Bangladesh. Morphological variations in the liver can be congenital or pole of the spleen on CT image.Beaver tail liver is an E-mail: [email protected] acquired. The congenital abnormalities of the liver anatomic variation of liver where the elongated left lobe include agenesis, atrophy or hypoplasia of lobes, extends laterally to contact or often wrap the spleen accessory lobes, accessory fissures etc. There are few (Figure: 4-A, B). ABSTRACT spleen after abdominal injury or when there is Liver scintigraphy is a specialized nuclear medicine imaging technique unexplained pain in the right upper quadrant of the used to diagnose hepatic pathological conditions as well as to assess the abdomen. Enlargement of the liver or spleen and colloid function of the liver. Itis also used to follow the progress of treatment of shift may also be noted on this scan (11). When certain diseases. This procedure may be referred as liver-spleen scan abdominalultrasound finding is inconclusive, liver-spleen because the spleen is alsoevaluateddue to its proximity and close scan along with SPECT-CT correlation may help to reach functional relationship to liver.SPECT-CT correlation along with planar images increases the specificity of the test and can guide the physicians in proper diagnosis by avoiding misinterpretation of DISCUSSION to rule outdiagnostic dilemma regarding certain hepatic & splenic certain physiological or pathological conditions. lobe is larger than the left lobe. Embryologically, it diseases. Here, we present a case where the patient was initially This scan may be done for the diagnosis of certain clinical Liver is the largest viscera in the abdomen. It occupies develops from an endodermal evagination of the suspected tohave splenomegaly
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