Copyfight 0 Actu R ~ d f o l o g1997 i~~ Acta Radiologica 38 (1997) 309-310 Printed in Denmark ' A l l right3 reserved ACTA RADIOLOGICA ISSN 0284-1851 ACCESSORY LOBE>> Lobe (anatomy) OF THE LIVER>> Liver MIMICKING A MASS IN THE LEFT ADRENAL GLAND>> Adrenal gland A case report M. HASHIMOTO,OOMACHI J. WATARAI K. and Department of Radiology, Akita University School of Medicine, Akita City, Akita, Japan Abstract An accessory lobe>> Lobe (anatomy) of the liver>> Liver is a rare anomaly which we have diagnosed in a patient by CT>> X-ray computed tomography. The lesion>> Lesion appeared as a soft-tissue-density mass with the same density as the liver>> Liver and attached to the liver>> Liver. Radionuclide liver>> Liver scintigraphy>> Scintigraphy helped to confirm the diagnosis. The object of this report is to draw attention to this rare entity since it can cause diagnostic confusion>> Mental confusion. Key words: Liver, anomaly; CT>> X-ray computed tomography. Correspondence: Manabu Hashimoto, Department of Radiology, Akita University School of Medicine, 1-1- 1 Hondo, Akita City, Akita 010, Japan. FAX +81 188 36 26 23. Accepted for publication 19 September 1996. An accessory lobe>> Lobe (anatomy) of the liver>> Liver is a rare entity, most often detected incidentally. We describe the imaging findings in a case of an accessory lobe simulating a mass in the left adrenal gland>> Adrenal gland. min) was performed. The tracer accumulated in the mass (Fig. 2). Few days later, the patient was asymptomatic>> Asymptomatic. Discussion Case report A 20-year-old woman presented with upper abdominal pain>> Abdominal pain and nausea>> Nausea. Six months earlier, she had had the same symptoms. Physical examination, standard hematological>> blood and biochemical>> Biochemistry tests, as well as upper gastrointestinal>> Human gastrointestinal tract examinations, were all normal. She underwent ultrasonography>> Medical ultrasonography (US), as a routine abdominal examination, which showed a mass in the region of the left adrenal gland>> Adrenal gland. CT>> X-ray computed tomography was done to clarify the situation. A soft-tissue mass with the same density as the liver>> Liver on both plain and contrastenhanced images was seen projecting from under the surface of the left lobe>> Left lobe of liver of the liver>> Liver (Fig. 1). The diagnosis of an accessory lobe>> Lobe (anatomy) of the liver>> Liver was considered at this oint. To confirm the diagnosis, liver>> Liver scintigraphy>> Scintigraphy (w mTc-galactosyl human serum albu- Anomalies of the liver>> Liver are uncommon. In a laparoscopic series of 1060 cases, the incidences of ectopic>> Ectopia liver>> Liver and accessory lobe of the liver>> Liver were 0.47% and 0.09%, respectively (7). Accessory liver>> Liver Fig. I . a) Plain and b) contrast-enhanced CT>> X-ray computed tomography show a mass (+) connected to the left lobe>> Left lobe of liver of the liver>> Liver and of the same density as the liver>> Liver tissue. Calcification is noted in the left adrenal gland>> Adrenal gland. 309 M. HASHIMOTO ET AL. accessory lobe of the liver>> Liver by showing the lesion>> Lesion as a soft-tissue-density mass with the same density as the liver>> Liver and attached to the liver>> Liver as in our case. In cases where the diagnosis is still doubtful, correlation with radionuclide scanning may help to confirm the diagnosis. However, confusion>> Confusion
!! Mental confusion may arise when images are interpreted as showing a solid mass lesion>> Mass effect (medicine). Therefore it is important for the radiologist>> radiology to be aware of this rare entity. An accessory lobe is usually of little clinical importance. However, symptoms are reported (1, 3-6) such as abdominal pain>> Abdominal pain that recurs over several years (1, 5). In our case, it is highly uncertain as to whether or not the accessory lobe of the liver>> Liver was the cause of the patient’s symptoms. REFERENCES Fig. 2. Liver scintigraphy (posterior view). Tracer accumulates in the mass (+). lobes have been found in several sites, including the gallbladder>> Gallbladder area, the hepatogastric ligament>> Hepatogastric ligament, near the umbilicus, adrenal gland>> Adrenal gland, pancreas>> Pancreas, or esophagus>> Esophagus, or in the thoracic cavity>> thoratic cavity. The most frequent location is the gallbladder>> Gallbladder area (7). According to COLLAN et al. (2), liver>> Liver tissue continuous with the main liver>> Liver is termed an accessory lobe of the liver>> Liver, while liver>> Liver tissue in the vicinity of the liver>> Liver, without such communication, is termed ectopic>> Ectopia liver>> Liver. In most cases, these anomalies are small and asymptomatic>> Asymptomatic. Therefore detection of these entities by imaging studies>> medical imaging is rare. CT may aid in establishing the diagnosis of an 310 1. CHAMPETIER YVERR., LETOUBLON & VIGNEAU A J., C. B.: general review of anomalies of hepatic>> liver morphology and their clinical implications. Anat. Clin. 7 (1985), 285. Y., A. J.: 2. COLLAN HAKKILUTE & HASTBACKA Ectopic>> Ectopia liver>> Liver. Ann. Chir. Gynaecol. 67 (1978), 27. 3. LLORENTE & DARDIK Symptomatic accessory lobe of J. H.: the liver>> Liver associated with absence of the left lobe>> Left lobe of liver. Arch. Surg. 102 (1971), 221. S. I.: 4. OMANIK & JABLONSKYPedunculated accessory hepatic>> liver lobe. Ann. Surg. 105 (1972), 792. 5. PUJARI D. & DEODHARE G.: Symptomatic accessory B. S. lobe of the liver>> Liver with a review of the literature. Postgrad. Med. J. 52 (1976), 234. Y., M., Y. et 6. TOMOOKA TORISU FUJIMURA al.: Symptomatic accessory lobe of the liver>> Liver associated with hyperthyroidism>> Hyperthyroidism. J. Pediatr. Surg. 23 (1988), 1055. 7. WATANABE MATSUDA TAKATORIet al.: Five cases of M., T., Y. ectopic>> Ectopia liver>> Liver and a case of accessory lobe of the liver>> Liver. Endoscopy 21 (1989), 39.