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February 1986, Volume 36, Issue 2

Original Article


Zahida Sabih  ( Atomic Energy Medical Centre, Nishtar Medical College and Hospital, Multan. )
Durr-e-Sabih  ( Atomic Energy Medical Centre, Nishtar Medical College and Hospital, Multan. )
Sher Mohammad Khan  ( Atomic Energy Medical Centre, Nishtar Medical College and Hospital, Multan. )


Five hundred ‘Normal’ liver scans were analysed to find out the incidence of various shapes of normal liver. There were differences between our series and the series reported in the of literature. The differences may be due criteria or geographical variation. JPMA 36: 33, 1986).


The liver is the largest solid organ in the human body1 .it is a pliable organ and is moulded by adjacent structures such as the right lung and right kidney. Supradiaphragmatic abscesses can flatten the top of the right lobe, or the dome the liver may move upwards as a result of splinting of the diaphragm or phrenic nerve paralysis. The liver exhibits many variations in shape on radionuclide scanning. The left lobe of the liver may be prominent, yielding a quadrilateral con­figuration or it may be so small that it cannot be seen. The porta hepatis may be prominent. The gallbladder may indent the inferior margin of the right lobe. The rib cage may indent the liver producing a linear defect2-4 Riedel’s lobe, a tojigue like downward projection of the right lobe may be felt as a mobile tumour in the right side of the abdomen and may be confused with other tumours in this area5. The objective of the present study was to find out the normal shapes of the liver in our area and compare our findings with those reported in the literature.


Five hundred normal scans were included in this study. ‘Normal’ liver was defined as having a size of not more than 17 Cm in the maximñm vertical diameter as seen on scanning in an adult of average build. Gamma camera image of the liver which showed marked extension below the costal margin were not included. Scans showing splenomegaly, cold areas or a non.homogenous distribution of radiocolloid were excluded.
All scans were performed with Tc99m labelled tin colloid and 1.5 3 mCi (55.5 111 MBq) was injected intravenously and imaging commenced soon afterward. Only those scans were included where both the authors agreed on a liver shape.
There were 233 males and 267 females. The male to female ratio being 1:1.2. The ages ranged from 1 year to 96 years and the mean age was 40.6 years. The variants which were included were triangular, prominent left lobe, poorly developed left lobe and poorly developed inferior tip of the right lobe.


The findings are given in table I and II.

6In the present study the predominant liver shape was triangular (8 1.2%), followed by prominent left lobe (6.4%), prominent dome of the right lobe (4.8%) and Riedel’s lobe (4.6%). Two cases of situs inversus were also seen E0.4%). There were rib indentations in 13 cases (2.6%) and the inferior tip of the right lobe was poorly developed in 9 cases (1.8%); The comparison of present results with those of Mc Afee et al. 6 are given in table-III.

Figures 1 & 2 show line drawing and Gamma Camera images of various shapes of the liver.
Our findings and those of Mc Afee et al. were analysed using the chi square test. The dif­ferences noted were statistically significant (P < 0.01). In one study6, there was no difference in the surface areas of normal livers between caucasians and negroes. Our findings may be due to different selection criteria or interpretor’s bias but it is also tempting to postulate a regional or racial variation. Similar studies in other areas of the country may be helpful.
Liver scan remains one of the most frequently requested investigation in our de. partment and scan findings frequently determine the course of the patients subsequent manage. ment, therefore knowledge of normal variants is essential for proper interpretation.


Hafiz Ghulam Abbas, Senior Scientific Officer, Atomic Energy Medical Centre, Multan did the statistical analysis. Dr. Abdur Rauf Khan, M.D., FACP., of the Department of Nuclear Medicine, University of Buffalo, New York helped with the literature survey. Their help is grate­fully acknowledged.


1. Snell, R.S. Clinical anatomy; for medical students. 2nd ed. Boston, Little, Brown, 1981, p. 200.
2. Deland, F. and Wagner, H. ed. Atlas of nuclear medicine. Philadelphia, Saunders, Vol. 3, p. 84.
3. Maisey, M.N., Britton, K.E. and Gilday, D.L. ed. Clinical nuclear medicine. London, Chapman and Hall. 1983, p.292.
4. Leonard, M., Freeman, Chien Hsing Meng, Philip, M., Johnson, et al. False Positive Liver Scans caused by disease processes in adjacent organs and structures. Br. J. Radiol., 1969; 42; 651-656.
5. Sherlock, S. Diseases of the liver and biliary system. 6th ed. Oxford, Blackwell, 1981: p. 4.
6. McAfee, J.G., Ause, R.G. and Wagner, H.N. Diagnostic Value of scintillation scanning of the liver. Arch. Intern. Med., 1965; 116: 95.

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