Liver Lobe Torsion

Based on Accession # 155108Trisha OuraAug 1 2011

Sam Czito• 10 yo MC German Shepherd X• 5 days lethargy/inappetance, fever• Bloodwork:

– ALT, ALP, mildly elevated total bilirubin– Leukocytosis– Mildly prolonged PTT

• Acute episode of collapse, vestibular signs at rDVM• Tachycardic, weak pulses at NCSU• Diagnostic Imaging:

– Thoracic radiographs: pleural effusion, no evidence of metastatic disease– Abdominal ultrasound: trace peritoneal effusion, small volume

retroperitoneal effusion, …

Differentials?Liver lobe torsion vs. infarction?

Liver Lobe Torsion in Dogs

• Uncommon (< 2006, only 25 reports in veterinary literature, 11 of them dogs)– Reported in dogs, cats, horses, pigs, rabbits, otters

• Largest case series = 13 dogs in 2006– Large breed dogs; median age 10yo– Chronic or acute onset of nonspecific signs (lethargy,

anorexia)– Mature leukocytosis, ALT, AST, +/- TB, mixed

coagulation results (most are normal, 2 with prolonged PT or PTT)

Liver Lobe Torsion in Dogs

• Abdominal radiographs: abdominal mass effect +/- gas distension of GI tract

• Abdominal ultrasound: non-cavitated mass, hypoechoic or heteroechoic liver with reduced or absent blood flow

• Abdominal effusion in 6/9 ultrasounded• Pleural effusion in 1/13 cases (no cause for

pleural effusion identified at necropsy)

Schwartz. JAVMA 2006.

Liver Lobe Torsion in Dogs

• Most common = left medial or left lateral (previously reported left lateral = most common)

• 11/13 survived immediate post-op; mean follow-up period = 14 mos

• 3 dogs died related to GDV during follow-up period

Cause?• Traumatic disruption to hepatic

ligaments?

• Left lateral more common because of laxity of hepatogastric ligament? Large size? Relative mobility?

• Stretching of triangular ligament with intermittent gastric dilation?– Splenic torsions reported with

chronic gastric dilation

• Agenesis or dysgenesis of ligaments?

• Vigorous jumping? Torse your liver AND burn 700 cal/hr

Misc• Case report of venous infarction and torsion of 2 lobes• Case report of young puppy with torsion of 2 lobes

– Initially diagnosed as splenic torsion based on radiographs

• Torsion vascular compromise, hypoxia and necrosis• Clostridium spp. migration via portal vein overgrowth and

emphysema & further necrosis• Hepatic fracture can occur with subsequent hemoabdomen

Complications

FYI

• Splenic infarction (case series of 16 dogs) ultrasound findings:– Splenic enlargement– Hypoechoic, heteroechoic, lacy appearance

(diffuse)– Focal change in echogenicity (hypo or hyperechoic

or cavitary lesion)– Subcapsular fluid– Visible thrombi in splenic vein in < 50%

References• Hardie EM et al. Splenic infarction in 16 dogs: a retrospective

study. J Vet Intern Med 1995;9:141-148.

• Scheck MG. Liver lobe torsion in a dog. Can Vet J 2007;48:423-425.

• Schwartz SG et al. Liver lobe torsion in dogs: 13 cases (1995-2004). J Am Vet Assoc 2006;228:242-247.

• Sonnenfield JM et al. Radiographic and ultrasonographic findings of liver lobe torsion in a dog. Vet Rad Us 2001;42:344-346.

• von Pfeil DJ et al. Left lateral and left middle liver lobe torsion in a saint bernard puppy. J Am Anim Hosp Assoc 2006;42:381-385.