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Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content

BACKGROUND: Computed tomography (CT) images of livers may show a hypo-attenuated structure alongside the falciform ligament, which can be a focal fatty pseudolesion and can mimic a malignancy. The preferred location is on the right parafissural site, ventral in segment IVa/b. The etiology is not cle...

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Autores principales: Klein, Willemijn M., Sonnemans, Lianne J. P., Franckenberg, Sabine, Fliss, Barbara, Gascho, Dominic, Prokop, Mathias, Lamers, Wouter H., Hikspoors, Jill P. J. M., Thali, Michael J., Flach, Patricia M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984698/
https://www.ncbi.nlm.nih.gov/pubmed/31986149
http://dx.doi.org/10.1371/journal.pone.0221544
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author Klein, Willemijn M.
Sonnemans, Lianne J. P.
Franckenberg, Sabine
Fliss, Barbara
Gascho, Dominic
Prokop, Mathias
Lamers, Wouter H.
Hikspoors, Jill P. J. M.
Thali, Michael J.
Flach, Patricia M.
author_facet Klein, Willemijn M.
Sonnemans, Lianne J. P.
Franckenberg, Sabine
Fliss, Barbara
Gascho, Dominic
Prokop, Mathias
Lamers, Wouter H.
Hikspoors, Jill P. J. M.
Thali, Michael J.
Flach, Patricia M.
author_sort Klein, Willemijn M.
collection PubMed
description BACKGROUND: Computed tomography (CT) images of livers may show a hypo-attenuated structure alongside the falciform ligament, which can be a focal fatty pseudolesion and can mimic a malignancy. The preferred location is on the right parafissural site, ventral in segment IVa/b. The etiology is not clear, nor is it known how the histology of this location develops. These are evaluated in this study. METHODS: 40 adult cadavers with autopsy and / or postmortem CT in a university hospital and a forensic center were included. Liver biopsies were taken at the left side of the falciform ligament as control, and at the right side as the possible precursor of a pseudolesion; these were examined for collagen and fat content. Cadavers with steatotic (>5% fat) or fibrotic (>2% collagen) control samples were excluded. RESULTS: Significantly more collagen was present in the right parafissural liver parenchyma: median 0.68% (IQR: 0.32–1.17%), compared to the left side 0.48% (IQR: 0.21–0.75%) (p 0.008), with equal fat content and CT attenuation values. The etiophysiology goes back to the demise of the umbilical venes in the early embryonic and neonatal period. CONCLUSIONS: The right parafissural area contains more collagen and an equal amount of fat compared to the control left side. This supports the hypothesis of delayed, ‘third’ inflow: the postnatal change in blood supply from umbilical to portal leaves the downstream parafissural area hypoperfused leading to hypoxia which in turn results in collagen accumulation and the persistence of paraumbilical veins of Sappey.
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spelling pubmed-69846982020-02-07 Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content Klein, Willemijn M. Sonnemans, Lianne J. P. Franckenberg, Sabine Fliss, Barbara Gascho, Dominic Prokop, Mathias Lamers, Wouter H. Hikspoors, Jill P. J. M. Thali, Michael J. Flach, Patricia M. PLoS One Research Article BACKGROUND: Computed tomography (CT) images of livers may show a hypo-attenuated structure alongside the falciform ligament, which can be a focal fatty pseudolesion and can mimic a malignancy. The preferred location is on the right parafissural site, ventral in segment IVa/b. The etiology is not clear, nor is it known how the histology of this location develops. These are evaluated in this study. METHODS: 40 adult cadavers with autopsy and / or postmortem CT in a university hospital and a forensic center were included. Liver biopsies were taken at the left side of the falciform ligament as control, and at the right side as the possible precursor of a pseudolesion; these were examined for collagen and fat content. Cadavers with steatotic (>5% fat) or fibrotic (>2% collagen) control samples were excluded. RESULTS: Significantly more collagen was present in the right parafissural liver parenchyma: median 0.68% (IQR: 0.32–1.17%), compared to the left side 0.48% (IQR: 0.21–0.75%) (p 0.008), with equal fat content and CT attenuation values. The etiophysiology goes back to the demise of the umbilical venes in the early embryonic and neonatal period. CONCLUSIONS: The right parafissural area contains more collagen and an equal amount of fat compared to the control left side. This supports the hypothesis of delayed, ‘third’ inflow: the postnatal change in blood supply from umbilical to portal leaves the downstream parafissural area hypoperfused leading to hypoxia which in turn results in collagen accumulation and the persistence of paraumbilical veins of Sappey. Public Library of Science 2020-01-27 /pmc/articles/PMC6984698/ /pubmed/31986149 http://dx.doi.org/10.1371/journal.pone.0221544 Text en © 2020 Klein et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Klein, Willemijn M.
Sonnemans, Lianne J. P.
Franckenberg, Sabine
Fliss, Barbara
Gascho, Dominic
Prokop, Mathias
Lamers, Wouter H.
Hikspoors, Jill P. J. M.
Thali, Michael J.
Flach, Patricia M.
Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content
title Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content
title_full Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content
title_fullStr Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content
title_full_unstemmed Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content
title_short Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content
title_sort pseudolesion in the right parafissural liver parenchyma on ct: the base is found in embryology and collagen content
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984698/
https://www.ncbi.nlm.nih.gov/pubmed/31986149
http://dx.doi.org/10.1371/journal.pone.0221544
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