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Background: The aim of this study is to clarify the regeneration of the CL (caudate lobe) without any reconstructions of short hepatic veins (SHVr) after LDLT (living donor liver transplantation) and compare the regeneration of the CL after right hepatectomy (Rt. Hx), as the surrogate model of extended left lobe graft (Ex LLG) with complete SHVr. Methods: Eleven Ex LLGs with CL were included in this study. SHVr was not performed in all cases. The volumetry was performed before, one month and six months after LDLT. Seven patients who underwent Rt. Hx were also included in this study as the surrogate model. Results: In Ex LLGs with CL, the regeneration rate of the large CL (> 30 ml) was worse than that of small CL (

The coexistence of multiple synchronous primary malignancies is uncommon. The coexistence of hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) is even rarer. We present a case of a 44-year-old male patient with a history of chronic hepatitis B and a right renal mass treated by radical nephrectomy. At the 2-month follow-up, a new lesion was detected in the left lobe of the liver. Postsurgery histologic evaluation with immunohistochemical study of both lesions confirmed the renal and hepatic lesions to be RCC and HCC, respectively.

The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.

To investigate the effect of b value and size of region of interest (ROI) on apparent diffusion coefficient (ADC) measurement and its reproducibility in liver diffusion-weighted imaging (DWI). Thirty-six volunteers underwent liver DWI twice with b values of 0, 100, 500, and 800 s/mm2. ADCs were measured with ROI of 50 mm2 on ADC maps generated with different b values of (0, 100), (0, 500), (0, 800), (0, 100, 500), (0, 100, 800), (0, 500, 800), and (0, 100, 500, 800) s/mm2. ADCs from b values of (0, 800) s/mm2 were measured with 4 ROI sizes (50, 100, 200 and 300 mm2). ANOVA analysis was used to compare differences of ADCs among different ROI sizes and different combined b values. Bland–Altman method was used to assess reproducibility of ADC measurement. ADCs with larger ROI size were slightly higher than those with smaller one, while no statistical difference was found (P > 0.05). And reproducibility of ADC measurement with different ROI sizes was comparable (LOA 7.0–8.2% for right lobe, 14.15–17.4% for left lobe). ADCs statistically decreased with increased maximum b values (P

PURPOSE OF REVIEW This review describes the history and current state of left lobe living donor liver transplantation (LDLT). The transplant community continues to face an organ shortage on a global scale, and the expansion of LDLT is attractive because it allows us to provide life-saving liver transplants to individuals without drawing from, or depending on, the limited deceased donor pool. Donor safety is paramount in LDLT, and for this reason, left lobe LDLT is particularly attractive because the donor is left with a larger remnant. RECENT FINDINGS This article reviews the donor and recipient evaluations for left lobe LDLT, discusses small for size syndrome and the importance of portal inflow modification, and reviews recipient outcomes in right lobe versus left lobe LDLT. SUMMARY Left lobe LDLT was the first adult-to-adult LDLT ever to be performed in Japan in 1993. Since that time, the use of both right and left lobe LDLT has expanded immensely. Recent work in left lobe LDLT has emphasized the need for inflow modification to reduce portal hyperperfusion and early graft dysfunction following transplant. Accumulating evidence suggests, however, that even though early graft dysfunction following LDLT may prolong hospitalization, it does not predict graft or patient survival.

Liver scintigraphy is a specialized nuclear medicine imaging technique used to diagnose hepatic pathological conditions as well as to assess the function of the liver. Itis also used to follow the progress of treatment of certain diseases. This procedure may be referred as liver-spleen scan because the spleen is alsoevaluateddue to its proximity and close functional relationship to liver.SPECT-CT correlation along with planar images increases the specificity of the test and can guide the physicians to rule outdiagnostic dilemma regarding certain hepatic & splenic diseases. Here, we present a case where the patient was initially suspected tohave splenomegaly with splenic hematomabut finally confirmedas unusuallyenlarged left lobe of liverand normal sized spleen with SPECT-CT of liver-spleen scan. Bangladesh J. Nuclear Med. 22(2): 161-165, Jul 2019

INTRODUCTION: The aim of the study was to know the intrahepatic ramication pattern of portal vein in left lobe of liver & its variations. METHODS: 25 human fresh livers were obtained after autopsy and studied by corrosion cast method. Polymeric granules of butyl butyrate were dissolved in acetone and 20% homogenous solution was made. Solution was injected into portal vein and the injected liver was placed in 10 % formal saline for 24 hours at room temperature (20°C) for polymerization of infused butyl butyrate solution. Maceration of liver tissue achieved by whole-organ immersion in 1.8 N KOH solution at 68°C for 24 hrs. Each cast thus obtained was preserved in glycerin and details were studied. RESULTS: The length of the transverse part of Left portal vein (LPV) varies from 1.5 -3.7 cm (2.6 cm) while the length of umbilical part of LPV varied from 0.5 – 1.5 cm. (1.1cm.) and total length of LPV varies from 2.0 cm.-4.8cm.(3.7cm). Ramication of Left Portal Vein was described on the basis of its umbilical part. Two type of pattern observed Type I (Umbilical Part Turned Inferiorly) 60 % cases & Type II (Umbilical Part Turned Superiorly). For segment II - Cranio- lateral (CAL) branch originated from the convexity of the curved portion of the umbilical part 84 % cases while in 16 % it has originated from the transverse part of the LPV. Segment III- Caudo- lateral branch (CRL) originated from the convexity of the curved portion of the umbilical part of LPV in all the cases. Segment IV- From the concavity, Inferio – medial branch ran downward & medially while superior- medial branch ran superiorly & medially to supply the lower & upper part of segment IV respectively. The both superio- medial & inferio-medial branches were present in 13 of 25 cases (52 %), while only superior -medial branches were present in 16 of 25 cases (64 %) cases & only inferio-medial 21 of 25 cases (84%) in cases. In 5 of 25 cases (20 %), a common trunk has originated from the concavity of curved portion of the umbilical part then it divided in to superior-medial & inferio-medial branches to supply the segment IV. The number of portal branches to the caudate lobe (segment I) varied from 1 to 4 branches: most commonly from LPV (52 %), then portal vein (16%) & then right portal vein12% cases. At least one of these branches was always originated from LPV (100%). The number of the branches to supply the caudate lode was 2 as it observed in 56 %, while 3 braches in 16 % cases & 4 branches were present in only 8% of the cases. The ndings of present CONCLUSIONS: study on hepatic vasculature have immense importance in the eld of hepato-biliary surgeries.

Background/Aim: Hepatocellular carcinoma represents the most frequently encountered liver malignancy worldwide; however the dimensions of these lesions rarely surpass 20 cm. In such cases surgical treatment might encounter significant technical difficulties. Case Report: We present the case of a 49-year-old patient diagnosed with a 22/25/21 cm left lobe hepatocellular carcinoma. Results: In order to achieve a safe and effective resection total vascular exclusion was needed. Moreover, due to the anatomical relationship between the tumor and the cava vein, an intrathoracic approach of the inferior cava vein was the option of choice. The time of total vascular exclusion was of 26 minutes while the length of surgery was of 210 minutes; meanwhile the estimated blood loss was of 650 ml, while the postoperative outcome was uncomplicated. Conclusion: Total vascular exclusion by double approach might be a safe alternative in order to minimize the risks of severe intraoperative and postoperative complications.

Liver abscess requiring drainage is conventionally managed by interventional radiology-guided percutaneous drainage (PCD). Radiologically inaccessible abscesses are managed with laparoscopic or open surgery, which carries high rates of morbidity and mortality.EUS-guided transluminal liver abscess drainage is minimally invasive and can be an alternative approach for caudate lobe, segment 4, and left lateral segment abscesses. We report on three consecutive patients with radiologically inaccessible left lobe liver abscess involving the caudate lobe, segment 4, and lateral segment in whom EUS-guided transluminal drainage using a modified technique was successful.

A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.

OBJECTIVES To compare the enucleation efficiency of Moses 2.0 with non-Moses technology in patients undergoing holmium laser enucleation of the prostate (HoLEP). PATIENTS AND METHODS A double-blinded, randomised study of patients undergoing HoLEP at the Mayo Clinic in Arizona, using the Lumenis Pulse™ 120H laser system. Patients were randomised to either right lobe enucleation using Moses 2.0 and left lobe enucleation using non-Moses, or the opposite. The primary outcome was individual lobe enucleation efficiency. Secondary outcomes included individual lobe laser time, laser energy, individual enucleation and haemostasis laser energies, and fibre burn back. Two independent reviewers watched videos of the procedures and provided a subjective evaluation of the technologies. RESULTS A total of 27 patients were included in the study. For the entire cohort, Moses 2.0 had less fibre degradation (3.5 vs 16.8 mm, P

Giant pedunculated hepatocellular adenomas are extremely rare tumors and often detected incidentally on cross-sectional imaging studies. We report the case of a 34-year-old woman who underwent cross-sectional imaging for staging evaluation of a uterine tumor. A large left subdiaphragmatic mass, without clear connection to the liver, was seen prompting diagnostic laparoscopy; during which a large pedunculated mass attached to the left lobe of the liver was found and resected. This case report highlights the challenges and pitfalls in the imaging diagnosis of pedunculated hepatocellular adenomas, such as difficulty in characterizing the mass or inability to identify the vascular attachment to the liver. Image-guided biopsy and diagnostic laparoscopy are valuable tools to establish diagnosis; most of these lesions are amenable to laparoscopic resection.

SummaryHemiagenesis of the thyroid gland (THA) represents a rare congenital anomaly. It is characterized by the absence of one thyroid lobe, and sometimes the isthmus as well. It can occur with all kinds of other thyroid pathologies that may be present in the remaining thyroid lobe. A case of a 21-year-old male patient is presented; he sought a thyroid consultation because of hair loss, fatigue, and problems concentrating, thus raising the suspicion of hypothyroidism. Thyroid function was normal, but sonography of the thyroid gland revealed THA of the left lobe and the isthmus. The current knowledge concerning the genesis and the clinical consequences of THA are discussed based on the current literature.

Background Primary hepatic myelolipoma is a rare hepatic mesenchymal tumor mixed by adipose tissue and bone marrow, and there is a lack of general guidelines related to its epidemiology and clinical management. Case summary A 26-year-old woman was admitted to our department complaining of a newly found tumor on her left lobe of the liver. The tumor was painless and not associated with any systemic or localized compressive symptoms. Serological tests disclosed a slight increase of gamma-glutamyl transpeptidase (70.0 U/L) and total bilirubin (19.2 μmol/L). Ultrasonography showed a mass about 5.0 cm × 5.0 cm in size that was located in the left lobe of the liver and displayed hyperechoic and well-encapsulated characteristics. Surgical resection was applied, and the following histopathological examination observed a variable proportion of myeloid tissues scattering throughout mature fibrotic adipose tissues, in which myeloid, erythroid, and megakaryocytic cells can be found in magnified view. The follow-up did not show any changes 6 mo after surgery. Conclusion This case highlights an extremely rare hepatic mesenchymal tumor, the primary hepatic myelolipoma, and discloses the common characteristics behind this disease and gives clinical recommendations.

To investigate whether a SPIO-labeling technique could enable MR visualization of the treatment margin after X-irradiation at a single dose of 30 Gy. Fifteen rats bearing N1-S1 hepatoma in either the left (group 1) or right (group 2) liver lobe were examined. Four hours after systemic SPIO administration, the left lobe was selectively irradiated at 30 Gy. Liver T2* maps were acquired 7 days later using a 9.4 T scanner. The livers were excised and examined histologically. The irradiated area showed T2*-weighted hypointensity with significantly shorter T2* values than those in the non-irradiated area (p

Liver exchange has been practiced in small numbers, mainly to overcome blood-type incom- patibility between patients and their living donors. A donor can donate either his smaller left lobe or the larger right lobe, although the former option is safer. Despite its elevated risk, right-lobe transplantation is often utilized due to size-compatibility requirement with the patient. We model liver exchange as a market-design problem, focusing on logistically simpler two-way exchanges. First, with two patient-donor sizes, we introduce an algorithm when only the safer left-lobe transplantation is feasible. We then introduce an individually rational, Pareto-efficient, and incentive-compatible mechanism that truthfully elicits the right- lobe-donation willingness of donors, and finally extend these results to a general model with any number of patient/donor sizes. The generalization requires new technical tools regarding bilateral exchanges under partial-order-induced preferences. Through simulations we show that not only liver exchange can increase the number of transplants by more than 30%, it can also increase the share of the safer left-lobe transplants.

An enlarged left lobe of liver can complicate bariatric surgery. Preoperative ultrasound of the abdomen is routinely performed in bariatric patients to measure the liver, particularly the left lobe, as well as to record any ancillary findings such as gallstones. Our study aims to evaluate the reliability of ultrasound in evaluating the craniocaudal length of the left lobe of the liver vis-a-vis intraoperative measurements. It also aims to assess the impact of ancillary findings detected on ultrasound, on the pre-surgical preparation and follow-up of such patients. Forty patients who were to undergo bariatric surgery in our hospital between June 2018 and May 2019 were included in this study. All of these patients underwent preoperative ultrasound. The measurements of the left lobe of liver evaluated on ultrasound were compared with the intraoperative measurements. Mean preoperative BMI for the forty patients was 41.47 kg/m2. On applying the paired t test, the left liver lobe measurements calculated by our ultrasound technique correlated with intraoperative measurements. The left liver lobe length measured less than 15 cm in all 40 patients. Ultrasound detected ancillary findings in 8 (20%) patients. Ultrasound showed fatty infiltration of liver in approximately 80% of the patients with a trend towards increasing incidence of fatty change with increasing BMI. Our study showed that left liver lobe measurements calculated by preoperative ultrasound correlate with intraoperative measurements. Ancillary ultrasound findings helped the surgeon in preparing for the bariatric surgery and may modify the follow-up protocol in such patients.

The liver is the largest gland of the body. It is involved in various metabolic activities. It is present in right hypochondrium, epigastric and reach up to left hypochondrium. Due to presence of falciform ligamentum, liver is divided into anatomical 5/6 right and 1/6 left lobe. During intrauterine life right lobe is larger due to haematopoiesis, but the haemopoietic function of liver is diminishes sufficiently in last two month leads to progressive reduction of its size which mostly affect left lobe. The study was carried out on 50 embalmed liver present in department of anatomy, GMERS medical college, Dharpur, Patan, Gujarat over the period of three year. Liver observed macroscopically for presence of any accessory lobe or fissure, then take photograph for record and further analysis. In our study out of 50 specimens 29(58%) specimen normal without any morphological changes, while in 21(42%) there are various changes. Out of 42% there is presence of accessory lobe in 7(14%), accessory fissure & grooves in 9(18%), Abnormal elongation of left lobe in 4 (8%) specimen and Riedel’s lobe in 1(2%) specimen. To identify primary or metastatic hepatic carcinoma hepatic imaging technique is best tool, in which various major fissure & lobes are very important landmark to mark the lobar anatomy and liver lesions. So it is helpful to radiologist as well as the surgeons to plan surgery accordingly. Keywords: Liver, Accessory lobe, Accessory fissure, Caudate lobe, Quadrate lobe.