[Absent liver dullness due to left-sided liver]

Abnormal organ sites may impede the interpretation of physical findings.

A 75-year-old man with hypertension had constipation and variable abdominal pain symptoms for a long time. He had no fever or abdominal pain at that time. Physical examination of the abdomen revealed high-pitched bowel sounds and hypertympanic percussion with absent liver dullness. An abdominal CT scan revealed coincidentally a left-sided liver, gallbladder and portal system. This was an explanation for the absent liver dullness.

Rare abnormalities in the anatomical position of organs (such as situs inversus or situs ambiguus) may confuse clinicians in the interpretation of the physical examination. It may lead to an atypical presentation of typical disease pictures, as well as to unfounded alarm symptoms. As far as we know an isolated left-sided liver has not been described before.