Year : 2004 | Volume
: 14 | Issue : 1 | Page : 53--54
A case report- hypoplastic right hepatic lobe - a rare anomaly
SK Sethi, RS Solanki
Lady Harding Medical College and Associated, Hospitals New Delhi, India
S K Sethi
Lady Harding Medical College and Associated, Hospitals New Delhi
|How to cite this article:|
Sethi S K, Solanki R S. A case report- hypoplastic right hepatic lobe - a rare anomaly.Indian J Radiol Imaging 2004;14:53-54
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Sethi S K, Solanki R S. A case report- hypoplastic right hepatic lobe - a rare anomaly. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Oct 15 ];14:53-54
Available from: http://www.ijri.org/text.asp?2004/14/1/53/28555
Hypoplasia of right hepatic lobe is a rare congenital anomaly that is sometimes associated with ectopy of gall bladder. In the past this anomaly was found incidentally by autopsy or operation. Nowadays CT and US are important in evaluation of hepatic morphology. We report one such case with hypoplasia of right hepatic lobe and anomalous position of gall bladder demonstrated on ultrasound and computed tomography.
An eight-year-old female child was admitted with complaints of pyrexia of unknown origin (PUO). Child gave no previous history of abdominal pain, previous surgery or trauma. On clinical examination the child was febrile, otherwise general physical and systemic examination was normal. US examination was done as part of PUO work up.
Ultrasound (US) revealed enlargement of the left hepatic lobe. The right hepatic lobe was hypoplastic and a linear hyperechoic area formed a boundary between left and right hepatic lobes [Figure 1]. However, US failed to image the gall bladder in its normal position. No intrahepatic biliary radicle dilatation was noted.
CT was performed to evaluate the hepatic lobes and gall bladder. CT revealed enlargement of the left hepatic lobe, especially medial segment. The right hepatic lobe was hypoplastic and a linear structure of low attenuation formed a boundary between left and right hepatic lobes. Gall bladder was located. posterior to the medial segment of the right lobe. [Figure 2]. Ligamentum Teres was seen to divide left hepatic lobe into medial and lateral segments. Hepatic flexure of colon was elevated and was placed posterolateral to the liver and gall bladder. Upward migration of right kidney was also noted; right kidney being higher than the left kidney. [Figure 3].
Anomalies of hepatic morphology are rare. Nevertheless, knowledge of such anomalies is important since they do not always remain clinically latent. Defective development of the left hepatic lobe can lead to gastric volvulus. Conversely, defective development of the right lobe of liver either remains clinically latent or leads to portal hypertension. The origin of the anomalies of hepatic morphology occurring in the course of organogenesis remains to be elucidated. The use of imaging now allows identification of such anomalies prior to the occurrence of an acute complication. 
Hypoplasia or agenesis of right hepatic lobe is a rare congenital anomaly. Before the introduction of cross sectional imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), it was discovered during laparatomy or autopsy or was detected by more invasive studies such as angiography. The imaging findings described include hypoplasia or agenesis of the right hepatic lobe, various degrees of enlargement of the medial and lateral segments of the left lobe and caudate lobe of liver, posterior interposition of the hepatic flexure of colon, superior migration of right kidney and anomalous position of the gall bladder. 
When the right lobe is absent the gall bladder is displaced posteriorly to a 'retrohepatic' location and the left lobe rotates to fill the hepatic fossa. The absence of the left lobe results in displacement of the gall bladder anteriorly towards the midline. 
Sonographic non-visualization of gall bladder could be the result of a wide range of pathological conditions, such as an atrophied stone-filled gallbladder, fistula with digestive tract or an advanced gallbladder tumour, but anomalous position of gallbladder must be considered in differential diagnosis. 
The hepatic lobe anomaly is not always congenital. Therefore, the diagnosis of this anomaly requires that the presence of cirrhosis or tumour, as well as any past history of hepatic surgery or trauma, be ruled out . In our case, there was no evidence of liver dysfunction, tumour or past history of hepatic surgery and trauma.
Hypoplasia of the right hepatic lobe or an anomalous gallbladder position may itself be of no clinical significance. However, it is important to consider hepatic and gall bladder anomalies in the differential diagnosis when the radiological studies reveal abnormal hepatic contours but fail to show the gallbladder in its normal position. CT is a useful modality for evaluating the hepatic anatomy and anomalous position of gall bladder . The present case highlights the CT and US features of hypoplastic right hepatic lobe a rare congenital anomaly.
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