Accessory liver within the thoracic cavity

Abstract

Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.

Segment VIII-Dependent Intrathoracic Accessory Liver

“…By comparison, an ectopic liver is one that is separated from the main liver without any connection to it [7]. With reference to these concepts, Mehmet et al propose a classification of intra thoracic accessory liver tissue based upon its location and its relationship with the orthotopic liver, as set out below (Figure 5) [2]: Type I: Direct extension of liver tissue into the thoracic cavity through a diaphragmatic defect. The case presented in this article corresponds to this type.…”

“…Although some cases have been associated with chest pain, dry cough or haemoptysis, it is accepted that the presence of liver tissue in the thoracic cavity rarely has a clinical impact [5,8]. However, it can be prone to the same pathological events as the abdominal liver and there are even authors who suggest a greater probability of hepatocellular carcinoma, hepatitis or cirrhosis than in the same [2,6]. Alternatively, the presence of a vascular pedicle can lead to the occurrence of ischaemic lesions due to its torsion, a condition previously described in intraabdominal accessory lobes [2,9,10].…”

“…However, it can be prone to the same pathological events as the abdominal liver and there are even authors who suggest a greater probability of hepatocellular carcinoma, hepatitis or cirrhosis than in the same [2,6]. Alternatively, the presence of a vascular pedicle can lead to the occurrence of ischaemic lesions due to its torsion, a condition previously described in intraabdominal accessory lobes [2,9,10]. Regarding the moment of diagnosis, most cases correspond to intraoperative findings during procedures performed for suspicion of a thoracic tumor of a different origin.…”

“…Abnormally positioned liver tissues are of low prevalence and are usually incidental findings diagnosed during imaging studies or surgical procedures [1]. Typically, they are located in the abdominal cavity, close to the orthotopic liver, and a supradiaphragmatic location is extremely rare [2][3][4][5][6]. Although an acquired aetiology is considered a possibility, especially following trauma or surgery, most of the cases described are of congenital origin, associated with defects in transverse septum development [3,6].…”

A rare intrathoracic mass: Accessory liver lobe

“…Some authors have argued that ectopic liver or ALL may progress into cancer, hepatitis, or local cirrhosis after a pathological alteration. [6,7] A thoracoscopy should be preferred as the first-line surgical approach. In our case, no resection was attempted, considering the size of the mass and the length of the pedicle, and the fact that the risk of twisting was not likely in our case.…”