Focal spared areas in fatty liver caused by regional decreased portal flow

Arai, Kunizo; Matsui, Osamu; Takashima, Tsutomu; Ida, M; Nishida, Yuji

doi:10.2214/ajr.151.2.300

Cited by 81 publications

(35 citation statements)

References 7 publications

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“…Focal fat sparing in diffuse fatty liver is reported and well described in the literature (8)(9)(10)(11)(12). It is speculated that fat sparing may occur due to altered fatty acid and triglyceride levels associated with different compositions of hormones in the portal flow and third inflow (2).…”

Section: Fat Sparingmentioning

confidence: 92%

Imaging of aberrant left gastric vein and associated pseudolesions of segments II and III of the liver and mimickers

Ünal¹,

Ozmen²,

Akata³

et al. 2015

Diagn Interv Radiol

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We present imaging findings of aberrant left gastric vein (ALGV) and associated pseudolesions and mimickers including metastases and focal nodular hyperplasia. ALGV is formed due to interrupted involution of anastomotic omental veins, and it can drain into left portal vein or segments II and III of the liver as third inflow. Focal fat, focal fat sparing, and perfusion changes can be seen due to the presence of ALGV, which can mimic metastasis in cancer patients. ALGV may also serve as a pathway for direct tumor spread into the liver in patients with gastric cancer. Magnetic resonance imaging can be used as a problem solving tool in the presence of equivocal findings on ultrasonography and computed tomography. Pseudolesions of the liver are a well-known issue and have been reported in the literature. These pseudolesions are caused by aberrant hepatopedal venous flow other than portal venous system, also known as third inflow. Third inflow is most commonly due to aberrant right gastric, paraumbilical, and cholecystic veins (1-3). Pseudolesions caused by aberrant left gastric vein (ALGV) are considered to be a more rare entity (4).The purpose of this study is to illustrate ALGV drainage into the liver and associated pseudolesions of segments II and III of the liver. In addition, we illustrate imaging findings of the mimickers of these pseudolesions. Embryology and anatomyThe left gastric vein receives branches of the inferior paraesophageal region and minor curvature of the stomach. Thereafter, it runs along the hepatogastric ligament and merges with the left aspect of the portal vein or confluence of the portal and splenic veins. The right gastric vein also receives blood from minor curvature of the stomach and merges with the right aspect of the portal vein.Aberrant left and right gastric veins develop due to morphogenetic changes during the developmental process in the early embryonic life (5). The main cause is interrupted involution of the anastomotic omental veins, so that typical left gastric vein does not form. Anastomotic omental veins are the anastomoses between primitive foregut venous plexus and ductus venosus, which normally exist during early embryonic life (5, 6).

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Section: Fat Sparingmentioning

confidence: 92%

Imaging of aberrant left gastric vein and associated pseudolesions of segments II and III of the liver and mimickers

Ünal¹,

Ozmen²,

Akata³

et al. 2015

Diagn Interv Radiol

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“…An appraisal of liver function based on volume could be considered questionable both before the posterior edge of segment IV in the porta hepatitis. [33][34][35] poietin) rapidly increases in plasma before DNA synthesis and liver regen- …”

Section: Methodsmentioning

confidence: 99%

Preoperative Portal Vein Embolization for Extension of Hepatectomy Indications

et al. 1996

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for patients who undergo curative resection. 6 Unfortunately, To render hepatectomy feasible in patients with an the percentage of patients likely to benefit from hepatic resecinitially deficient volume of the future remnant liver tion ranges from 5% 7 to 10% 8 in patients with adenocarci-(FRL), we redistributed portal blood flow rich in hepatonoma of the colon. trophic substances toward the FRL. Redistribution was As portal vein blood flow has hepatotrophic properties, 9 we achieved with preoperative portal vein embolization decided to reroute portal blood flow toward the FRL, in an (POPE) feeding the future resected liver. POPE was perattempt to achieve hypertrophy. The redistribution was formed in 31 patients, under fluoroscopic guidance, via achieved with preoperative portal vein embolization (POPE), a percutaneous access. POPE was well tolerated and surto increase the volume of an initially insufficient FRL and gery was practicable in 24 patients without severe postthus to widen the possibilities of curative resection. operative liver failure. Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL. PATIENTS AND METHODSFRL volume values were 90 to 560 mL (mean 260 mL) before POPE and 160-783 mL (mean 443 mL) after POPE, From September 1989 to June 1995, we undertook a study of which represents a median increase of 79% { 50%. Hy-31 consecutive POPEs in 31 patients with tumor involving the pertrophy of the FRL was 90% { 52% after 30 days with liver. There were 18 men and 13 women, 16-78 years old (mean 58 years old). Of these 31 patients 22 had metastases from colorectal cyanoacrylate, 53% { 6% after 43 days with Gelfoam, and (mean 26 months), disease-free survival was 0-60 months Twenty-six patients had multiple lesions, and 5 had a single bulky (mean 19 months), and 7 patients are disease-free and lesion. Six patients had benefited from hepatic artery infusion alive 14 to 60 months (mean 43 months) after surgery. chemotherapy (3-20 courses, mean 9), whereas 10 others had had Although exclusively applicable in a limited subset of systemic chemotherapy. In all patients computed tomography durpatients, POPE widens the possibilities of curative hepa-ing arterial portography showed extensive involvement of the liver 11 below 10% at 15 minutes), the FRL volliver failure. 3 The successful resection of liver tumors is there-ume was below the acceptable limit of 25% of the complete liver fore dependent on the volume of the future remnant liver volume. In 7 patients with an altered indocyanine green test and/ (FRL). In clinical practice, this can occur (1) when there is a or who had received previous intra-arterial chemotherapy, the small left lobe and an extended right hepatectomy is manda-FRL volume was below 33% of the complete liver volume.The portal vein was accessed, via a subxyphoid route, under sonotory and (2) when major liver surgery is necessary in patients graphic and fluoroscopic guidance, by percutaneous placement of a with impaired liver function secondary to cirrhosis...

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“…Focal fatty liver change (FFLC) is a pathological condition that has been recognized with increasing frequency, with the widespread use of US [8]. The cause of FFLC has not been clarified, although some authors have speculated that the regional disturbance of intrahepatic portal blood flow may be an important factor [3,7]. Hepatic US in humans with FFLC demonstrates the presence of focal hyperechogenicity in a relatively non-echogenic organ [9,12].…”

mentioning

confidence: 99%

“…In human medicine, some authors [3,7] have proposed that regional differences in blood flow might be an important factor in explaining the focal nature of the process, but it is also possible that these differences are a result, rather than a cause, of fat depositions. In the present case, the lesion did not appear to be ischemic, because the supplying vessels detected at necropsy were similar in size to those in normal parts, and there was no evidence of venous outlet obstruction.…”

mentioning

confidence: 99%

Focal Fatty Liver in a Heifer: Utility of Ultrasonography in Diagnosis

et al. 2004

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ABSTRACT. A 30-month-old Holstein heifer presented with a history of decreased appetite and respiratory signs. Sonographic examination of the liver incidentally revealed an area of increased echogenicity between the portal vein and the gallbladder. The lesion was nonspherical and had no mass effect or displacement of the adjacent vessels. Its boundaries, to the liver, were geographic. The liver specimen was histologically compatible with a diagnosis of focal fatty liver change (FFLC). The sonographic features of focal fatty infiltration of the liver are characteristic. Recognition of the ultrasonographic data is important to differentiate FFLC from other lesions. KEY WORDS: bovine, focal fatty liver change, ultrasonography.J. Vet. Med. Sci. 66(3): 341-344, 2004 In dairy cows, diagnosis of fatty infiltration of the liver has been based mostly on history, clinical signs and biochemical analyses. Recently, ultrasonography (US) has been used in the evaluation of fatty infiltration in dairy cows [1,2], and the findings obtained agreed with the results of histologic examination of liver biopsy specimens. Focal fatty liver change (FFLC) is a pathological condition that has been recognized with increasing frequency, with the widespread use of US [8]. The cause of FFLC has not been clarified, although some authors have speculated that the regional disturbance of intrahepatic portal blood flow may be an important factor [3,7]. Hepatic US in humans with FFLC demonstrates the presence of focal hyperechogenicity in a relatively non-echogenic organ [9,12]. These focal areas, which may vary widely in size, shape and border characteristics, are generally observed in the periportal area, near the gallbladder [11]. A search of the veterinary literature disclosed little information in cattle [6]. In this note, we present a heifer demonstrating unusual infiltration of fat into the liver. The ultrasonographic, laboratory and clinicopathologic findings of the case are documented.A 30-month-old Holstein heifer presented at the Veterinary Teaching Hospital of Rakuno Gakuen University for investigation of decreased appetite and respiratory signs. Cattle in the same herd had experienced some periparturient diseases such as mastitis, ketosis and fatty liver. On the first examination, the animal was thin, had only a moderate appetite, 38°C rectal temperature, 80 beats/min pulse rate and 16 breaths/min respiratory rate. Rumen movements were decreased. Auscultation of the thorax revealed hypervesicular sounds especially on the carnioventral lung lobes. Blood gas analysis was consistent with moderate hypoxaemia. Arterial blood gas results were PaO 2 , 62.9 mmHg, PaCO 2 , 49.8 mmHg and pH 7.47. ECG recordings did not reveal any abnormal findings. Higher activity of aspartate aminotransferase (319 IU/l) and high concentrations of total bilirubin (0.90 mg/dl) indicated a moderate degree of hepatic impairment. The thorax and the abdomen were scanned from dorsal to ventral, by means of an ultrasound scanner equipped with a 3.5 MHz linear transd...

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Focal spared areas in fatty liver caused by regional decreased portal flow

Cited by 81 publications

References 7 publications

Imaging of aberrant left gastric vein and associated pseudolesions of segments II and III of the liver and mimickers

Imaging of aberrant left gastric vein and associated pseudolesions of segments II and III of the liver and mimickers

Preoperative Portal Vein Embolization for Extension of Hepatectomy Indications

Focal Fatty Liver in a Heifer: Utility of Ultrasonography in Diagnosis

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