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

Willemijn M. Klein; Lianne J. P. Sonnemans; Sabine Franckenberg; Barbara Fliss; Dominic Gascho; Mathias Prokop; Wouter H. Lamers; Jill P. J. M. Hikspoors; Michael J. Thali; Patricia M. Flach

doi:10.1371/journal.pone.0221544

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

Willemijn M. Klein^*, Lianne J. P. Sonnemans, Sabine Franckenberg, Barbara Fliss, Dominic Gascho, Mathias Prokop, Wouter H. Lamers, Jill P. J. M. Hikspoors, Michael J. Thali, Patricia M. Flach

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Article number	0221544
Number of pages	13
Journal	PLOS ONE
Volume	15
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0221544
Publication status	Published - 27 Jan 2020

Keywords

COMPUTED-TOMOGRAPHY
MAGNETIC-RESONANCE
FALCIFORM LIGAMENT
FATTY LIVER
POSTMORTEM
PREVALENCE
SPLEEN

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10.1371/journal.pone.0221544Licence: CC BY

Cite this

@article{b41dbf0153094cd5a24ecc5e20fb2953,

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

abstract = "BackgroundComputed 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.Methods40 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.ResultsSignificantly 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.ConclusionsThe 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.",

keywords = "COMPUTED-TOMOGRAPHY, MAGNETIC-RESONANCE, FALCIFORM LIGAMENT, FATTY LIVER, POSTMORTEM, PREVALENCE, SPLEEN",

author = "Klein, {Willemijn M.} and Sonnemans, {Lianne J. P.} and Sabine Franckenberg and Barbara Fliss and Dominic Gascho and Mathias Prokop and Lamers, {Wouter H.} and Hikspoors, {Jill P. J. M.} and Thali, {Michael J.} and Flach, {Patricia M.}",

note = "Publisher Copyright: {\textcopyright} 2020 Klein et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2020",

month = jan,

day = "27",

doi = "10.1371/journal.pone.0221544",

language = "English",

volume = "15",

journal = "PLOS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "1",

}

TY - JOUR

T1 - Pseudolesion in the right parafissural liver parenchyma on CT

T2 - The base is found in embryology and collagen content

AU - Klein, Willemijn M.

AU - Sonnemans, Lianne J. P.

AU - Franckenberg, Sabine

AU - Fliss, Barbara

AU - Gascho, Dominic

AU - Prokop, Mathias

AU - Lamers, Wouter H.

AU - Hikspoors, Jill P. J. M.

AU - Thali, Michael J.

AU - Flach, Patricia M.

N1 - Publisher Copyright: © 2020 Klein et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2020/1/27

Y1 - 2020/1/27

N2 - BackgroundComputed 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.Methods40 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.ResultsSignificantly 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.ConclusionsThe 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.

AB - BackgroundComputed 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.Methods40 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.ResultsSignificantly 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.ConclusionsThe 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.

KW - COMPUTED-TOMOGRAPHY

KW - MAGNETIC-RESONANCE

KW - FALCIFORM LIGAMENT

KW - FATTY LIVER

KW - POSTMORTEM

KW - PREVALENCE

KW - SPLEEN

U2 - 10.1371/journal.pone.0221544

DO - 10.1371/journal.pone.0221544

M3 - Article

C2 - 31986149

SN - 1932-6203

VL - 15

JO - PLOS ONE

JF - PLOS ONE

IS - 1

M1 - 0221544

ER -