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Liver Lobe Torsion

Liver Lobe Torsion . Based on Accession # 155108 Trisha Oura Aug 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

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Liver Lobe Torsion

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  1. Liver Lobe Torsion Based on Accession # 155108 Trisha Oura Aug 1 2011

  2. 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, …

  3. Differentials? Liver lobe torsion vs. infarction?

  4. 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)

  5. 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)

  6. Schwartz. JAVMA 2006.

  7. 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

  8. 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

  9. Complications 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

  10. 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%

  11. 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.

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