Liver lobe disparity consequent upon atrophy. Diagnostic, operative and therapeutic considerations

Liver lobe disparity consequent upon lobar atrophy with compensatory hypertrophy of the contralateral lobe is a pathological entity usually encountered with high bile duct obstruction and is associated with particular diagnostic and operative problems, discussed here by reference to 10 patients. The hypertrophied lobe presented as an abdominal 'mass' in all 10 whilst the atrophied lobe imitated a 'cold' area on liver scintigraphy and was misinterpreted as a tumour in 2 cases. The operative difficulties, exemplified by 8 patients, arise from the distortion of the configuration of the liver, the alteration of the anatomical relations of the vascular and biliary structures, and the reduced functional capacity of the atrophied liver. Pre-operative diagnosis of the condition is important to allow optimal treatment.