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Various causes of hepatic capsular retraction: CT and MR findings

D M Yang, MD, H S Kim, MD, S W Cho, MD and H S Kim, MD

Department of Radiology, Gachon Medical College Gil Medical Center, 1198, Guwol-Dong, Namdong-Gu, Incheon 405-760, South Korea



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  		Figure 1. CT scan of a 66-year-old woman with hepatocellular carcinoma, obtained during the (a) arterial and (b) delayed phase of enhancement after injection of contrast material. This shows a heterogeneously enhanced mass with capsular retraction in the right hepatic lobe.

 


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  		Figure 2. Portal phase CT scan of a 56-year-old man with an intrahepatic cholangiocarcinoma shows a hypodense mass in the left hepatic lobe. There is a focal capsular retraction adjacent to the mass (arrow).

 


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  		Figure 3. Portal phase CT scan of a 74-year-old man with liver metastases from colon cancer shows multiple hypodense masses in both hepatic lobes. Hepatic capsular retraction is seen adjacent to the right hepatic mass.

 


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  		Figure 4. Portal phase CT scan of a 32-year-old woman with liver metastases from breast cancer shows focal hepatic capsular retraction adjacent to a right hepatic mass.

 


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  		Figure 5. (a) Portal and (b) delayed phase CT scans of a 65-year-old man with liver metastases from pancreas cancer show a hypodense mass with capsular retraction in the right hepatic lobe (arrow).

 


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  		Figure 6. CT scan of a 62-year-old woman with hepatocellular carcinoma obtained 2 months post transcatheter arterial chemoembolization shows a focal capsular retraction of the right hepatic lobe and dense accumulation of iodized oil in the tumour.

 


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  		Figure 7. 47-year-old man with Hodgkin's disease. (a) Portal phase CT scan shows a hypodense mass in the liver. (b) CT scan obtained 7 months after systemic chemotherapy shows capsular retraction of the liver. The size of the hepatic mass is decreased.

 


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  		Figure 8. 51-year-old woman with a hepatic hemangioma. (a) Portal phase CT scan shows a hypodense mass with peripheral nodular enhancement in the right hepatic lobe. (b) Delayed phase CT scan shows progressive centripetal enhancement of the mass. Focal retraction of the liver capsule is seen adjacent to the hepatic mass (arrow).

 


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  		Figure 9. 39-year-old man with confluent hepatic fibrosis. (a) Arterial phase CT scan shows a wedge-shaped, low attenuated lesion with retraction of the liver capsule in the right hepatic lobe (arrow). (b) On delayed phase CT, the lesion is isoattenuated to the liver parenchyma. (c) On T1 weighted MRI the lesion is lower signal intensity than the adjacent liver parenchyma. (d) On T2 weighted MRI, the lesion is hyperintense.

 


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  		Figure 10. 63-year-old woman with oriental cholangiohepatitis. (a) Unenhanced CT scan shows high-attenuated stones in the bile ducts of the right hepatic lobe. (b) Arterial phase CT scan shows transient parenchymal enhancement and dilatation of the bile duct in the right hepatic lobe. Focal capsular retraction of the liver is noted (arrow). (c) On portal phase CT scan, the right hepatic parenchyma is homogeneous.

 


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  		Figure 11. 53-year-old man with hepatocellular carcinoma post-transcatheter arterial chemoembolization (TACE). (a) Portal phase CT scan shows dense accumulation of iodized oil in the right hepatic mass (arrow). (b, c) T2 weighted MR images obtained 5 months post-TACE with an emulsion of 30 mg of adriamycin and 3 ml of iodized oil, shows a dilatation of right intrahepatic bile ducts. This finding suggests bile duct necrosis as a complication of TACE. The right hepatic mass, with retention of iodized oil, is hypointense (arrow). (d, e) On dynamic fast low angle shot (FLASH) MR images obtained 30 s after injection of contrast media, the right hepatic mass is not enhanced (arrow). (f) Portal phase CT scan obtained 19 months post-TACE shows severe atrophy of hepatic parenchyma and a capsular retraction in the right hepatic lobe (arrow).

 


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  		Figure 12. CT scan of a 49-year-old woman with pseudoretraction of the hepatic capsule by accessory fissure shows a shallow indentation of the right hepatic lobe, which mimics capsular retraction of the liver (arrow).

 


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  		Figure 13. CT scan of a 55-year-old man with hepatocellular carcinoma shows multiple hypodense masses in the right hepatic lobe. The normal liver parenchyma (arrow) between the masses mimics capsular retraction of the liver.

 




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