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- Ever seen an ectopic liver?
Jeongyun Jeong, Jupill Chang, Seunghee Lee, Kyuchang Kim, Jaehwan Kim, Kidong Eom
Background
Intrathoracic ectopic liver is a rare condition in veterinary medicine, often misdiagnosed as a diaphragmatic hernia due to overlapping clinical and radiographic features. This case study details the diagnostic process for a 5-year-old Maltese dog with suspected diaphragmatic hernia, aiming to highlight the utility of computed tomography (CT) in distinguishing ectopic liver from other thoracic masses.
Methods
A 5-year-old spayed female Maltese with no clinical signs of illness underwent thoracic and abdominal radiography, followed by abdominal surgery and CT imaging for further evaluation. Histopathological examination was performed on a biopsy of the intrathoracic mass to confirm its identity. Measurements and contrast-enhanced CT were used to assess the structure and vascular connections of the mass.
Results
-Radiographic Findings: Thoracic radiographs revealed a soft tissue mass (4.1 × 3.6 × 4.2 cm) in the right caudal thorax, with loss of the dome-shaped diaphragm contour. Differential diagnoses included diaphragmatic hernia, diaphragmatic eventration, or caudal mediastinal mass.
-CT Findings: The CT scan showed a soft tissue mass in the thoracic cavity connected to the liver at the diaphragm. The mass shared similar density and contrast enhancement as liver lobes and had visible portal and hepatic veins connecting it to the liver.
-Surgical Findings: The diaphragm was intact during exploratory surgery, and all liver lobes were present and appeared normal. The mass adhered moderately to the diaphragm and mildly to the mediastinum but was not excised due to risks of hemorrhage.
-Histopathology: The mass exhibited hepatocellular vacuolar degeneration (hydropic/glycogenic subtype), confirming it as ectopic liver tissue.
Limitations
Positive contrast peritoneography and ultrasound Doppler were not utilized, which might have provided additional diagnostic clarity.
Variations in liver morphology across dogs could influence the interpretation of findings.
The causes of the vacuolar degeneration and perfusion disorder observed in the ectopic liver were not explored further.
Conclusions
The study underscores the importance of including intrathoracic ectopic liver as a differential diagnosis when radiography shows a caudal thoracic mass with loss of diaphragm contour. CT imaging is instrumental in confirming liver tissue by identifying vascular connections and assessing the integrity of the diaphragm. Advanced imaging and careful surgical exploration are recommended to prevent misdiagnosis and guide appropriate management.
Postcontrast CT images in dorsal plane (A), sagittal plane (B), and transverse plane (C, D) in soft tissue window. A soft tissue mass in the right caudal thoracic cavity shows a similar density of liver tissue (asterisk). The arrow in (A) indicates a portal vein connected to the left branches of the hepatic portal vein, while the arrow in (B) indicates hepatic vein drainage into the left lobar hepatic vein. All liver lobes are identified. The arrowhead in (B) represents skin staples, and the arrowhead in (C) indicates peritoneal effusion secondary to initial surgery. RL, right lateral lobe; RM, right medial lobe; QL, quadrate lobe; LL, left lateral lobe; LM, left medial lobe; PP, papillary process of caudate lobe; CP, caudate process of the caudate lobe.
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