Hot quadrate sign

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Hot quadrate sign
Differential diagnosis SVC syndrome (indirect)

A hot quadrate sign is an imaging appearance of increased enhancement in CT scans or MRI, or radiotracer accumulation in nuclear medicine, in which there is enhancement of the quadrate lobe of the liver. The appearance is an indirect reflection of the collateralized flow of SVC syndrome, in which occlusion of the superior vena cava leads to preferential flow to the quadrate. [1]

The sign is similar in mechanism but distinct in significance from the hot caudate sign , in which the caudate lobe of the liver shows preferential enhancement or radiotracer accumulation with hepatic vein occlusion in Budd Chiari syndrome. In the latter, the caudate shows preferential flow because its direct drainage into the inferior vena cava remains unobstructed, as opposed to the remnant liver which drains into the hepatic vein. [2]

Related Research Articles

Inferior vena cava One of two veinous trunks bringing deoxygenated blood back to the heart

The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra.

Budd–Chiari syndrome

Budd–Chiari syndrome is a very rare condition, affecting one in a million adults. The condition is caused by occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites, and liver enlargement. The formation of a blood clot within the hepatic veins can lead to Budd–Chiari syndrome. The syndrome can be fulminant, acute, chronic, or asymptomatic. Subacute presentation is the most common form.

Umbilical vein

The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood volume and for administration of glucose and drugs.

Portal hypertension

Portal hypertension is hypertension in the hepatic portal system – made up of the portal vein and its branches, that drain from most of the intestine to the liver. Portal hypertension is defined as a hepatic venous pressure gradient. Cirrhosis is the most common cause of portal hypertension; other, less frequent causes are therefore grouped as non-cirrhotic portal hypertension. When it becomes severe enough to cause symptoms or complications, treatment may be given to decrease portal hypertension itself or to manage its complications.

Abdominal aorta

The abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

Superior vena cava syndrome Group of symptoms caused by obstruction of the superior vena cava

Superior vena cava syndrome (SVCS), is a group of symptoms caused by obstruction of the superior vena cava ("SVC"), a short, wide vessel carrying circulating blood into the heart. The majority of cases are caused by malignant tumors within the mediastinum, most commonly lung cancer and non-Hodgkin's lymphoma, directly compressing or invading the SVC wall. Non-malignant causes are increasing in prevalence due to expanding use of intravascular devices, which can result in thrombosis. Other non-malignant causes include benign mediastinal tumors, aortic aneurysm, infections, and fibrosing mediastinitis.

Ductus venosus

In the fetus, the ductus venosus shunts a portion of umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver. Compared to the 50% shunting of umbilical blood through the ductus venosus found in animal experiments, the degree of shunting in the human fetus under physiological conditions is considerably less, 30% at 20 weeks, which decreases to 18% at 32 weeks, suggesting a higher priority of the fetal liver than previously realized. In conjunction with the other fetal shunts, the foramen ovale and ductus arteriosus, it plays a critical role in preferentially shunting oxygenated blood to the fetal brain. It is a part of fetal circulation.

Hepatic veins

The hepatic veins are the veins that drain de-oxygenated blood from the liver into the inferior vena cava. There are usually three upper hepatic veins draining from the left, middle, and right parts of the liver. These are larger than the group of lower hepatic veins that can number from six to twenty. All of the hepatic veins drain into the inferior vena cava.

Inferior vena cava syndrome

Inferior vena cava syndrome (IVCS) is a constellation of symptoms resulting from obstruction of the inferior vena cava. It can be caused by physical invasion or compression by a pathological process or by thrombosis within the vein itself. It can also occur during pregnancy. Pregnancy leads to high venous pressure in the lower limbs, decreased blood return to the heart, decreased cardiac output due to obstruction of the inferior vena cava, sudden rise in venous pressure which can lead to placental separation, and a decrease in kidney function. All of these issues can arise from lying in the supine position during late pregnancy which can cause compression of the inferior vena cava by the uterus. Symptoms of late pregnancy inferior vena cava syndrome consist of intense pain in the right hand side, muscle twitching, hypotension, and fluid retention.

Transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension which frequently leads to intestinal bleeding, life-threatening esophageal bleeding and the buildup of fluid within the abdomen (ascites).

Portal vein thrombosis

Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. The mortality rate is approximately 1 in 10.

Hepatic portal system

In human anatomy, the hepatic portal system is the system of veins comprising the hepatic portal vein and its tributaries. It is also called the portal venous system and splanchnic veins, which is not synonymous with hepatic portal system and is imprecise.

Congestive hepatopathy

Congestive hepatopathy, is liver dysfunction due to venous congestion, usually due to congestive heart failure. The gross pathological appearance of a liver affected by chronic passive congestion is "speckled" like a grated nutmeg kernel; the dark spots represent the dilated and congested hepatic venules and small hepatic veins. The paler areas are unaffected surrounding liver tissue. When severe and longstanding, hepatic congestion can lead to fibrosis; if congestion is due to right heart failure, it is called cardiac cirrhosis.

A portacaval shunt is a treatment for portal hypertension. A connection is made between the portal vein, which supplies 75% of the liver's blood, and the inferior vena cava, the vein that drains blood from the lower two-thirds of the body. The most common causes of liver disease resulting in portal hypertension are Budd–Chiari Syndrome or Cirrhosis. Budd–Chiari should not be mistaken for Cirrhosis.

Omental foramen

In human anatomy, the omental foramen, is the passage of communication, or foramen, between the greater sac, and the lesser sac.

Liver Vertebrate organ involved in metabolism

The liver is an organ only found in vertebrates which detoxifies various metabolites, synthesizes proteins and produces biochemicals necessary for digestion and growth. In humans, it is located in the right upper quadrant of the abdomen, below the diaphragm. Its other roles in metabolism include the regulation of glycogen storage, decomposition of red blood cells, and the production of hormones.

Congenital stenosis of vena cava

Congenital stenosis of vena cava is a congenital anomaly in which the superior vena cava or inferior vena cava has an aberrant interruption or coarctation.

An atriocaval shunt (ACS) is an intraoperative surgical shunt between the atrium of the heart and the inferior vena cava. It is used during the repair of larger juxtahepatic vascular injuries such as an injury to the local vena cava. Injuries to the inferior vena cava are challenging, those behind the liver being the most difficult to repair.

Liver segment

A liver segment is one of eight segments of the liver as described in the widely used Couinaud classification in the anatomy of the liver. This system divides the lobes of the liver into eight segments based on a transverse plane through the bifurcation of the main portal vein.

Lobes of liver

The human liver is divided grossly into four parts or lobes. The four lobes are the right lobe, the left lobe, the caudate lobe, and the quadrate lobe. Seen from the front – the diaphragmatic surface the liver is divided into two lobes the right lobe, and the left lobe. Viewed from the underside – the visceral surface, the other two smaller lobes the caudate lobe, and the quadrate lobe are also visible. The two smaller lobes, the caudate lobe and the quadrate lobe are known as superficial or accessory lobes and both are located on the underside of the right lobe.

References

  1. Virmani, V; Lal, A; Ahuja, CK; Khandelwal, N (2010). "The CT Quadrate lobe hot spot sign". Annals of Hepatology. 9 (3): 296–8. PMID   20720272.
  2. Dickson, AM (November 2005). "The focal hepatic hot spot sign". Radiology. 237 (2): 647–8. doi:10.1148/radiol.2372031690. PMID   16244273.