Distending the stomach with sufficient water can substantially improve visualization of elongated left lobe of the liver at ultrasound, potentially improving detection of tumors in the liver and preventing misdiagnosis.
Aims: The aim of this study was to evaluate the impact of anatomical variation of the elongated left lobe of the liver on the ultrasound detection of focal liver lesions. Materials and methods: We evaluated, by ultrasonography (US), 296 patients with elongated left lobe of the liver and 30 patients with focal lesions in the normal length left lobe of the liver. Those patients had undergone prior computed tomography (CT) evaluation. Results: Of the 296 patients evaluated, 34 patients had focal lesions (the size range 11-20 mm) in the distal region of the elongated left lobe of the liver, and none of the lesions was visualized at US examination (p<0.001). All the focal lesions in the normal length left lobe of the liver of the 30 patients were visualized by US without significant difference between the dimensions established by CT and US (p=0.136). Conclusion: Focal lesions in the distal region of elongated left lobe of the liver are difficult to be detected by conventional US examination and the main reason is the impact of anatomical localization on the examination protocol.
The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion.
Focal fatty sparing may change with fatty liver changes over time, and it is sometimes not appreciable on sonography, although it is often evident on CT. These findings imply that if differentiation between focal fatty sparing and a tumor is undetermined and follow-up is performed, should any change occur, then an abnormality that is no longer appreciable at follow-up is probably focal fatty sparing rather than a true tumor.
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