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.
MATERIAL AND METHODS
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.
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.