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Not hepatic infarction: Cold quadrate sign.

Anderson H Kuo1, Sunita D Srivastava2, Samantha G Harrington1

  • 1Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America.

Clinical Imaging
|August 27, 2020
PubMed
Summary

A rare "cold" quadrate sign, indicating hepatic hypodensity due to systemic-portal venous shunting from inferior vena cava obstruction, was identified in a patient. This finding represents a "cold" variant of the known "hot" quadrate sign.

Keywords:
Inferior vena cavaLiver circulationPortosystemic shuntSuperior vena cava

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Area of Science:

  • Radiology
  • Hepatology
  • Vascular Imaging

Background:

  • The quadrate lobe of the liver can exhibit unique enhancement patterns on imaging.
  • The "hot" quadrate sign is a known finding related to venous drainage anomalies.
  • Inferior vena cava (IVC) obstruction can lead to systemic-portal venous shunting.

Observation:

  • A 50-year-old male presented with bilateral lower extremity edema.
  • Imaging revealed a wedge-shaped hypodense region in the hepatic quadrate lobe.
  • This hypoenhancement was attributed to systemic-portal venous shunting secondary to IVC obstruction.

Findings:

  • The observed hypodensity represents a
  • cold" quadrate sign, a variant of the hot quadrate sign.
  • Computed Tomography (CT) confirmed the diagnosis of IVC obstruction and associated shunting.
  • The study discusses the venous drainage pathways implicated in both hot and cold quadrate signs.

Implications:

  • This case highlights the importance of recognizing the "cold" quadrate sign as a potential indicator of IVC obstruction.
  • Understanding these venous anomalies aids in accurate diagnosis and management of hepatic and vascular conditions.
  • Further research into venous drainage variations can improve diagnostic accuracy in liver imaging.