The 'expanded gallbladder fossa sign' in liver cirrhosis

摘要

The pericholecystic space is often enlarged in patients with cirrhosis due to the presence of fat, with a resultant "expanded gallbladder fossa sign" [1]. The sensitivity, specificity, accuracy, and positive predictive value of this sign for the imaging diagnosis of cirrhosis were 68%, 98%, 80%, and 98%, respectively [1]. In healthy patients, the gallbladder is located on the visceral surface of the liver and fits in a fossa between the segment V and the medial segment of the left liver (segment IV), which contains minimal fatty tissue (Fig. la). By contrast, the "expanded gallbladder fossa sign" is considered present if there is enlargement of the pericholecystic space and if this space is bound laterally by the edge of the right hepatic lobe and medially by the edge of the segments II and III without the segment IV (Fig.1b). The following four factors have been identified as the cause of this sign in cirrhotic livers [1]: (a) atrophy of the segment IV, (b) atrophy of the right hepatic lobe (mainly the anterior segment), (c) enlargement of the lateral segment of the left liver (segments II and III) especially in the cephalocaudal direction, and (d) hypertrophy of the caudate lobe.