Bicavitary effusion secondary to liver lobe torsion in a dog

Abstract

We described the diagnosis and successful treatment of pleural and peritoneal effusion secondary to liver lobe torsion in a dog. A 12-year-old female spayed Borzoi dog was referred for heart failure. Emergency room thoracic and abdominal ultrasound showed a large volume of pleural effusion with mild peritoneal effusion and an abdominal mass. Pleural fluid analysis classified the effusion as exudative. A complete ultrasound revealed mild peritoneal effusion and decreased blood flow to the right liver lobe. Other causes of bicavitary effusion were ruled out based on blood work, ultrasound, echocardiogram, and computed tomography. The patient was taken to surgery and diagnosed with caudate liver lobe torsion and had a liver lobectomy. At the 2-week postoperative recheck, the patient was doing well and there was complete resolution of the pleural effusion. Liver lobe torsion is a rare occurrence in dogs and can be difficult to diagnose. Clinical signs are nonspecific for liver lobe torsion and patients may present in respiratory distress with significant pleural fluid accumulation. When assessing patients with pleural and peritoneal effusion, liver lobe torsion should be considered as a differential diagnosis.

Computed tomographic and clinical findings in a dog with suspected liver lobe torsion, secondary disseminated intravascular coagulation and multiorgan infarction

“…LLT is an uncommon condition, with only 32 cases described in dogs 1–16. It generally affects mature, medium‐breed to large‐breed dogs,1 although it has been reported in one small breed dog8 and two puppies 3 9.…”

“…The aetiology of LLT is poorly understood1–7 and the presenting signs are often unspecific 1 2. Ultrasonography and CT have been previously used in the work‐up of LLT,1 8–13 but diagnosis often relies on confirmation during surgery or postmortem 9. To the authors’ knowledge, this is the first case of a suspected LLT displaying a ‘whirl sign’ on CT, which is highly specific for diagnosing visceral torsion 17–19.…”

“…Liver lobe torsion (LLT) is infrequently seen in both human and veterinary patients 1–16. The aetiology of LLT is poorly understood1–7 and the presenting signs are often unspecific 1 2.…”

Diagnostic imaging for the assessment of acquired abdominal vascular diseases in small animals: A pictorial review

“…Organ torsion is an acute cause of vascular compromise that shows characteristic imaging features with both ultrasound and MDCT. Torsions of parenchymatous organs have been reported in small animals for the liver, spleen, and pancreas …”

“…With this review, the authors will discuss acquired vascular diseases with three main categories: (a) causes and consequences of diseases Torsions of parenchymatous organs have been reported in small animals for the liver, spleen, and pancreas. [34][35][36][37][38][39][40][41][42][43] The twirling of the mesenteric vessels allows the identification of the "whirl sign" or "whirlpool sign" on ultrasound and MDCT, which is a strong indicator of organ torsion (Figure 1). [44][45][46] On MDCT, it is also possible to identify swirling strands of soft tissue and fat attenuations also causing a "whirl sign" and endovascular hyperattenuating material in the twisted splenic vessels in the center of the "whirl sign," consistent with fresh thrombus (Figure 2).…”