Rapid growth of an intact human liver transplanted into a recipient larger than the donor.

Two individuals undergoing orthotopic hepatic transplantation received livers from donors who were on average 10 kg smaller than themselves based on recipient ideal body weight. As a result, the donor livers in these 2 cases were 29%-59% smaller than would be expected had the donor liver and recipient been matched ideally. The liver grafts in the recipients steadily increased in size, as determined by serial computed tomography scanning, to achieve new volumes consistent with those that would have been expected in a normal individual of the recipient's size, sex, and age. Fasting plasma levels of amino acids, glucagon, insulin, and standard liver injury tests were monitored to determine which measure best reflected the changes observed in the size of the grafts over time. No relationship between the changes observed in any of these parameters and hepatic growth was apparent. In both cases, the liver increased in volume at a rate of approximately 70 ml/day. These data demonstrate that a small-for-size liver transplanted into a larger recipient increases in size at a rate of approximately 70 ml/day until it achieves a liver volume consistent with that expected given the recipient's size, age, and sex.

Evidence that host size determines liver size: studies in dogs receiving orthotopic liver transplants.

Orthotopic liver transplantation was performed in two groups of dogs; Group I animals consisted of large dogs that served as recipients of livers obtained from smaller dogs while Group II animals consisted of dogs that received liver from donor dogs of nearly the same size. The small-for-size livers transplanted into the Group I dogs rapidly increased in size over the course of 2 weeks until they achieved a size equal to that originally present in the larger recipient dogs. In contrast, the livers transplanted into dogs of the same size as the donors underwent some degree of atrophy. In both groups of animals, plasma levels of insulin and glucagon and hepatic (graft) activities of thymidine kinase and ornithine decarboxylase were followed serially. The only difference between the two groups of animals for these measures was that the ornithine decarboxylase activity rose to a greater degree in the liver that underwent graft enlargement. These data suggest that recipient size determines, at least in part, liver graft size once it is transplanted. These data also suggest that of the parameters followed, only ornithine decarboxylase activity parallels the finding of growth of the transplanted liver.

Computed tomography of cavernous hemangiomas of the liver: how sure are we?

The computed tomography diagnosis of hepatic hemangiomas has been well documented. We cite a case that fulfilled the criteria for hemangioma, but was pathologically shown to be steatosis. Strict adherence to established criteria may lead to erroneous diagnosis.

Hepatic artery thrombosis after liver transplantation: radiologic evaluation.

Hepatic artery thrombosis after liver transplantation is a devastating event requiring emergency retransplantation in most patients. Early clinical signs are often nonspecific. Before duplex sonography (combined real-time and pulsed Doppler) capability was acquired in October 1984, 76% of all transplants in this institution referred for angiography with a clinical suspicion of hepatic artery thrombosis had patent arteries. In an effort to reduce the number of negative angiograms, CT, real-time sonography, and pulsed Doppler have been evaluated as screening examinations to determine which patients need angiography. Of 14 patients with focal inhomogeneity of the liver architecture detected by CT and/or real-time sonography, 12 (86%) had hepatic artery thrombosis, one had slow arterial flow with hepatic necrosis, and one had a biloma with a patent hepatic artery. In 29 patients undergoing duplex sonography of the hepatic artery, six (21%) had absence of a Doppler arterial pulse. All six had abnormal angiograms: Four had thrombosis, one had a significant stenosis, and one had slow flow with biopsy-proven ischemia. Of 23 patients with a Doppler pulse, two had hepatic artery thrombosis at surgery. However, real-time sonography demonstrated focal inhomogeneity in the liver in both cases. Our data demonstrate that pulsed Doppler of the hepatic artery combined with real-time sonography of the liver parenchyma currently is the optimal screening test for selecting patients who require hepatic angiography after liver transplantation. A diagnostic algorithm is provided.

In vivo hepatic volume determination using sonography and computed tomography. Validation and a comparison of the two techniques.

Ultrasonography and computed tomography were used to determine hepatic volume in vivo. The data obtained were compared with the weight and volume of the same livers after surgical removal at the time of orthotopic hepatic transplantation. The relationship between hepatic weight and volume was found to be linear over a 16-fold range of weights and a 19-fold range of volumes. The sonographic results more closely paralleled the results obtained directly. These data demonstrate that both methods can determine, within acceptable limits, hepatic volume or weight. The sonographic technique, however, is more accurate than the computed tomography scan method as it allows the use of sagittal scanning of the liver, which is superior to the transverse scanning technique required by the computed tomography scanner. In addition, these results demonstrate that these methods might be applied in the future for better matching of donors and recipients of orthotopic liver transplants.

Thoracic neurilemmoma: case report and review of the world literature.

Thoracic tumors are unusual and tend to occur in the posterior mediastinum. A case of anterior thoracic neurilemmoma is presented, with plain film, computed tomographic, and pathologic correlation. Diagnosis of chest wall masses, including the role of computed tomography, is discussed, along with the significance of calcification in these lesions.

Cystic mesoblastic nephroma.

Mesoblastic nephroma is the most common solid renal neoplasm in the first few months of life. It has been recognized only recently as a distinct entity, having been classified previously as Wilms tumor. There are relatively few ultrasonic descriptions of this entity in the literature. We present an additional case featuring a large peripheral cystic component with a solid central core demonstrated on ultrasonograhy. This feature is not specific for mesoblastic nephroma and occurs in cystic Wilms tumor.

Computerized axial tomography in the detection of intraocular foreign bodies.

CAT scanning was used in the localization of intraocular and periorbital foreign bodies in 36 consecutive patients. The method was found to be convenient, well-tolerated by the patient, and provided accurate and useful clinical information. Six cases are described to illustrate clinical situations where traditional localizing methods were unable to supply satisfactory information and where CAT scanning proved to be of significant assistance. This included uncooperative patients, multiple foreign bodies, anterior foreign bodies, and foreign bodies adjacent to the posterior scleral wall.

Chest xerotomography: evaluation of calcification within lung nodules.

Through the use of a chest phantom and beeswax nodules containing calcium, xerotomography is shown to be a valuable tool in the evaluation of calcifications within lung nodules. The technique gives superior definition of calcium, especially fine calcifications in the 1-2-mm, or less, range. Our results suggest that clinical trials should follow and clinicopathologic correlation be obtained.