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Left triangular ligament lesions are likely hepatic in origin: a systematic review
Siddharth Agarwal1,2, Rahul Munyal1, Aloysious Aravinthan3,4
1Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
The British Journal of Radiology
|September 25, 2023
Summary
Lesions in the left triangular ligament (LTL) are rare but often hepatic in origin. Recognizing these hepatic LTL lesions can prevent diagnostic delays and unnecessary procedures in the left upper quadrant (LUQ).
Area of Science:
- Hepatobiliary surgery
- Abdominal imaging
- Surgical pathology
Background:
- The left triangular ligament (LTL) connects the liver's left lobe to the diaphragm, traversing the left upper quadrant (LUQ).
- Lesions within the LTL are infrequent and can lead to diagnostic challenges.
- Cadaveric studies indicate the LTL can contain hepatic tissue, suggesting hepatic origin for LTL lesions.
Approach:
- A case series of two patients with LTL lesions was compiled.
- A systematic review of MEDLINE, EMBASE, PubMed, and Google Scholar was conducted for LTL lesion case reports up to September 2022.
- Included studies were analyzed to identify pathological processes affecting the LTL.
Key Points:
- The review identified 14 cases of LTL lesions from 12 studies.
- Seven cases involved mass lesions of hepatic origin, with three initially misdiagnosed as gastric tumors.
- Seven cases presented with postoperative bile leaks originating from aberrant biliary ducts within the LTL.
Conclusions:
- All identified mass lesions within the LTL were confirmed to be of hepatic origin.
- All iatrogenic injuries to the LTL resulted in bile leaks.
- Including hepatic lesions in the differential diagnosis for LUQ lesions is recommended to minimize diagnostic delays and avoid superfluous procedures.
