Cartilaginous compression of the liver - clinical and ultrasonographic aspects

The musculocartilaginous complex is a structure composed of cartilaginous, osseous and muscular elements, which is located at the thoracoabdominal junction, at the level of the right costal arch.

To determine the ultrasonographic characteristics of this complex under normal conditions as well as to demonstrate its effects on the liver depending on the constitutional body built, respiratory phase and patient's body position.

All abdominal ultrasound scans were performed between 2006 and 2015. A total of 1000 patients (566 females and 434 males aged between 35 and 82 years, mean age 52 years), who had no significant upper abdominal pathologies identified based on clinical and imaging data, were enrolled for the analysis. In addition to standard internal organ assessment, we also attempted to identify the symptoms of hepatic compression by the musculocartilaginous complex. We used 3-6 MHz convex and 7-12 MHz linear transducers. The degree of musculocartilaginous compression of the liver was assessed during breathing in supine and sitting position, as well as with trunk inclined forward.

The study showed that musculocartilaginous compression of the liver mostly affects females (96%) with leptosomatic body build. The complex compressing the liver shows a heterogeneous echostructure. Increased hepatic compression was observed during exhalation, in a sitting position and with trunk inclined forward.

Cartilaginous compression of the liver depends on body built and patient's body position. The musculocartilaginous complex may cause focal or segmental compression of the hepatic parenchyma, causing pain in the right upper abdomen in some patients.