PMC9549201_01
(A,B) Cross-sectional images of the first enhanced CT scan before admission on 25 April 2021 show 180  torsion of the left hepatic artery (arrow); (C) On 27 April 2021, compared with the previous CT scan, the enhanced CT scans repeated after the disappearance of abdominal pain symptoms suggested that the twisted hepatic artery has reset itself (arrows). LHA, left hepatic artery; CT, computed tomography.
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F1
On 25 April 2021, the abdominal enhancement computed tomography (CT) was performed in the Emergency Department of the Affiliated Hospital of Zunyi Medical University, suggesting a large mass of approximately 170 x 95 x 40 mm in size protruding into the pelvis and attached to the left lobe of the liver by a twisted stalk (Figures 1A,B). On 27 April 2021, a re-examination of the abdomen by contrast-enhanced CT revealed that the twisted AHL had spontaneously reverted to its location (Figure 1C).
(A) Coronal image of the enhanced CT scan on 27 April 2021 revealed the mass was visible as non-uniform reinforcement in the inferior portion; (A,B) CTA images illustrated that the left hepatic artery, the branch of the left hepatic vein, and the left branch of the portal vein were observed within the mass, but multiple filling defects are recognized inside the branch of the left hepatic vein. AHL, accessory hepatic lobe; TH, thrombosis; L, liver; LPV, left hepatic portal vein; BLHV, the branch of the left hepatic vein; LHA, left hepatic artery.
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F2
The AHL was visible as non-uniform reinforcement in the inferior portion, with density similar to the liver parenchyma (Figure 2A). The computed tomography angiography (CTA) illustrated that the left hepatic artery, the left hepatic vein branch, and the left branch of the portal vein were observed within the mass, but multiple filling defects were recognized inside the branch of the left hepatic vein (Figures 2A,B).
(A) Intraoperative images suggested the AHL has repositioned itself, with only a stalk of approximately 2 cm in diameter liver tissue forming an attachment to the left liver. (B,C) Excision of large AHL with thrombosis of a branch of the left hepatic vein. (D) The histopathology result demonstrated the irregular structure of the hepatic lobules, dilated hepatic sinusoids, and disordered vascular distribution in the portal area and interlobular. AHL, accessory hepatic lobe; S, stalk; TH, thrombosis; BLHV, branch of the left hepatic vein.
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F3
During the laparoscopic procedure, it was diagnosed that a giant AHL of an estimated size of 18 x 10 x 6 cm was visible at the left side of the hepatic round ligament, with only a 2 cm in diameter liver tissue forming a stalk adjacent to the left liver, through which the branch of the left hepatic vein, the left branch of the portal vein, the left hepatic artery, and the bile duct were passing through (Figure 3A). The branch of the left hepatic vein was dissected in vitro, and a large amount of thrombosis was obtained (Figures 3B,C). The histopathology result demonstrated the irregular structure of the hepatic lobules, dilated hepatic sinusoids, and disordered vascular distribution in the portal area and interlobular (Figure 3D).