Deceptions in localizing extrahepatic right-upper-quadrant abdominal masses by CT

Frick, MP; Sb, Feinberg

doi:10.2214/ajr.139.3.501

Cited by 17 publications

(3 citation statements)

References 5 publications

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“…Frick and Feinberg 1 have noted the deceptive appearance of right upper quadrant masses compressing and invaginating the liver posteriorly. The difficulty defining the exact point of origin of these masses is increased in large masses and in thin patients with sparse fat planes, or in cases where these planes are obliterated by malignant infiltration, inflammation or previous surgery.…”

Section: Discussionmentioning

confidence: 99%

Hepatic ‘pseudotumours’: Right upper quadrant masses mimicking intrahepatic tumours

Koea

Blumgart

2002

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Hepatic ‘pseudotumours’: Right upper quadrant masses mimicking intrahepatic tumours

Koea

Blumgart

2002

ANZ Journal of Surgery

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“…In our patient obstructive cholangitis and a painful growing abdominal mass were the leading symptoms. Biloma may be diagnosed by US 6,14,17,18. Other diagnostic procedures may also be useful as for example hepatic scintigraphy (HIDA) 11,19,20 (CT-scan) 21,22 Treatment may be operative or non-operative. Vujic and Brock 1981 23 reported non-operative treatment with percutaneous, ultrasonic or CT guided aspiration of biloma.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Biloma Secondary to Operative Common Bile Duct Injury

Colović

Perisić-Savić

1990

HPB Surgery

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Encapsulated collections of bile ("biloma") may be a sequela of liver trauma, operative injury or disease. Such collections may be intrahepatic or extrahepatic and usually in the supramesocolic compartment of the abdomen. This is a report of a retroperitoneal biloma, an entity that has been reported only twice to date but this is the first secondary to an operative common bile duct lesion.Evacuation of the biloma and reconstruction of the associated biliary stricture were successfully carried out. The patient remains sympton free with normal clinical and laboratory data more than 14 months after surgery.Operative common bile duct (CBD) injury may be followed by a number of complications. To our knowledge retroperitoneal biloma secondary to a CBD lesion has not been previously reported. CASE REPORTA 54 year old lady was submitted to elective cholecystectomy in a district hospital on 15/09/1988. Operative cholangiography was not performed. Soon after operation bile drainage through a subhepatic drain appeared and continued for four weeks. The patient subsequently developed bile peritonitis and was reoperated upon on 21/10/1988 and the abdominal cavity was drained. Bile drainage stopped by mid-January 1989 but was followed by jaundice. A third operation was performed on 23/02/89 for obstructive jaundice. The CBD could not be found and the abdomen was closed with drainage. In March 1989 percutaneous transhepatic cholangiography (PTC) was carried out clearly demonstrating a high CBD stricture. The procedure was followed by frequent attacks of severe cholangitis with a temperature of up to 40C.. Once while vomiting she felt "that something broke in the abdomen". After this episode the fever abated somewhat and the attacks of cholangitis became less severe. However, a painful enlarging right lower quadrant abdominal mass appeared.At the time of admission to our Institution on 31/03/1989 she was deeply jaundicied with a large tender right lower abdominal mass. Laboratory data indicated biliary obstruction (total serum bilirubin 302.5 mmol/l, serum alkaline phosphatase 6.9 U/I (normal value 1 to 2.5 U/l).

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“…Frick and Feinberg described that the difficulty of cr localization is due to concavity and pliability of the inferior hepatic surface; thus a mass arising from the right kidney and adrenal gland easily invaginates the pliable visceral hepatic surface. 3 Lim et al described that the lack of Gerota's fascia in the superior aspect of the perirenal space will cause easy invagination of a large [455][456][457][458][459]1990 lesion arising from the right adrenal or kidney through the bare area of the liver, mimicking a hepatic lesion and vice versa. 5 In addition, obliquity of the hepatorenal interface to the plane of cr section makes partial volume averaging of the fat in the perirenal and pararenal spaces.…”

Section: Discussionmentioning

confidence: 99%

Sonographic sliding sign in localization of right upper quadrant mass.

Lim¹,

Ko²,

Lee³

1990

Journal of Ultrasound in Medicine

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Sonographic sliding sign is the observation of dynamic motion of a mass against adjacent organs during respiratory movement or extrinsic pressure. We applied this sign for prospective study in nine patients, each of whom had a large posterior right upper abdominal mass arising from the liver, kidney, or adrenal gland. The sign was found to be very reliable as a criterion for the localization of the origin of the mass in all patients except in the following two cases: a Wilm's tumor that invaded the retroperitoneum and posterior abdominal wall was regarded as a retroperitoneal tumor invading the kidney; and in the other one, an adrenal pheochromocytoma, the sliding sign against the liver and the right kidney was equivocal. In conclusion, judicious use of the sonographic sliding sign will greatly assist in the localization of a large right upper abdominal mass, especially when there is a paucity or lack of retroperitoneal fat.

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Deceptions in localizing extrahepatic right-upper-quadrant abdominal masses by CT

Cited by 17 publications

References 5 publications

Hepatic ‘pseudotumours’: Right upper quadrant masses mimicking intrahepatic tumours

Hepatic ‘pseudotumours’: Right upper quadrant masses mimicking intrahepatic tumours

Retroperitoneal Biloma Secondary to Operative Common Bile Duct Injury

Sonographic sliding sign in localization of right upper quadrant mass.

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