Morphological Variations of Caudate Lobe of the Liver and their Clinical Implications.

ABSTRACT

Background: Knowledge of normal and variant anatomy of the caudate lobe of the liver is a prerequisite for better surgical outcome. Morphology of the caudate lobe has significance in diagnostic imaging and also minimally invasive surgical approaches. So we have taken up this study to know the detailedmorphology of the caudate lobe. Materials andmethods: Themorphology of caudate lobe was studied in 100 formalin fixed adult livers obtained from the department of anatomy, Kempegowda institute of medical sciences and Bangalore medical college, Bangalore. The livers were studied for the morphological variations of the caudate lobe. Results: Various shapes of the caudate lobe were noticed. Vertical fissure extending upwards from lower border was seen in 30%. Prominent papillary process was seen in 21%. Prominent caudate process was seen in 9%. Discussion: Various shapes of the caudate lobe were encountered in the present study. Sahni et aland Joshi SD et al also reported a variety of shapes of the caudate lobe. Vertical fissure extending upwards from the inferior border was seen in 30% of the livers. Kogure et al noticed the notch in approximately half of the patients undergoing hepatectomy. Kogure et al also noted that the external notch may be a vestige of the portal segmentation of the caudate lobe. Prominent papillary process was observed in 21%of the livers. Joshi SD et al have also found prominent papillary process in 33% of the livers in their study. Auh et al observed that on CT (Computed Tomography), a normal or small papillary process may be mistaken for enlarged porta hepatis lymph nodes. When enlarged papillary process extends on to left side it can mimic pancreatic body mass. Conclusion: The incidence of morphological variations of caudate lobe is very high in this study. The papillary process of caudate lobe is a potential source of pitfalls in interpretation of CT images at and just below the porta hepatis. Knowledge of these variations is important for radiologists to achieve correct diagnosis and for surgeons to plan for surgery and to achieve good surgical outcome.