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CASE SNIPPET
Year : 2023  |  Volume : 69  |  Issue : 3  |  Page : 184-185

Beaver tail variant of liver: A radiographic mimic of left lower lobe pneumonia in a neonate


Department of Pediatrics, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India

Date of Submission17-Aug-2022
Date of Decision28-Oct-2022
Date of Acceptance31-Oct-2022
Date of Web Publication24-Jan-2023

Correspondence Address:
Dr. P Parekh
Department of Pediatrics, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.jpgm_657_22

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How to cite this article:
Parekh P, Shah P, Bhaisara B. Beaver tail variant of liver: A radiographic mimic of left lower lobe pneumonia in a neonate. J Postgrad Med 2023;69:184-5

How to cite this URL:
Parekh P, Shah P, Bhaisara B. Beaver tail variant of liver: A radiographic mimic of left lower lobe pneumonia in a neonate. J Postgrad Med [serial online] 2023 [cited 2023 Sep 24];69:184-5. Available from: https://www.jpgmonline.com/text.asp?2023/69/3/184/368461




Pneumonia is one of the commonest differential diagnoses of a homogeneous opacity on chest X-ray. In the absence of clinical and laboratory evidence of infection, it is important to investigate for pathologies which may mimic consolidation on chest X-ray but may be related to extrathoracic abnormalities.

A full-term male child was born by emergency cesarean section in view of fetal distress. His Apgar scores were 8 and 9 at 1 and 5 min, respectively. He had mild respiratory distress with an oxygen saturation of 99% on room air. On respiratory examination, he had reduced air entry on the lower side of the left chest. Chest X-ray [Figure 1] revealed a homogeneous, well-defined opacity in the lower lobe of the left lung with blunting of the costophrenic angle, suggestive of left lower lobe consolidation with pleural effusion. However, his sepsis screen was negative, and the neonate was clinically stable and feeding well.
Figure 1: Chest X-ray showing a well-defined, homogenous opacity in the lower lobe of the left lung with blunting of the left costophrenic angle (arrow)

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An ultrasonography of the thorax and abdomen showed an enlarged left lobe of the liver. A computed tomography (CT) of the abdomen showed an elongated left lobe of the liver reaching up to the left hypochondrium and roofing the spleen [Figure 2]a and [Figure 2]b. The liver parenchyma was otherwise unremarkable. This abnormal morphology of liver was identified as beaver tail liver. Interestingly, on review of chest X-ray, this enlarged left lobe of liver mimicked left lower lobe consolidation. The neonate had uneventful hospital stay and was discharged.
Figure 2: CT abdomen showing (a) enlarged left lobe of the liver reaching up to the left upper quadrant of the abdomen (arrow); (b) enlarged left liver lobe (arrow) encircling the spleen (asterisk)

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Beaver tail liver, also known as a sliver of liver, is a variant of normal hepatic morphology with an elongated left liver lobe extending laterally up to the left hypochondrium and often surrounding the spleen.[1] The term was coined because of its resemblance to a beaver's tail. Identification of this variant is clinically important in trauma patients, as the left upper quadrant abdominal trauma can cause injury to the left lobe of the liver and can be misdiagnosed as subcapsular splenic hematoma or perisplenic fluid collection. Additionally, this variation may prove fatal during invasive procedures of the abdomen.[2-4]

To our knowledge, this is the first reported case of a beaver tail variant of liver in a neonate. It may mimic a lung pathology on chest X-ray as seen in the present case. Clinical percussion in older children and adults will reveal a dull note in the left lower chest, as it is occupied by the beaver tail variant of liver. A lower lobe pneumonia will also have dullness on percussion, but it can be differentiated from the liver by performing vocal resonance or tactile vocal fremitus. However, as this clinical examination is challenging in a neonate, a simple bedside ultrasonography can help reach the diagnosis. Thus, a differential diagnosis of beaver tail variant should be considered in radiologically suspected left lower lobe pathologies in appropriate clinical setting.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Atalar MH, Karakus K. Beaver tail liver. Abdom Radiol 2018;43:1851-2.  Back to cited text no. 1
    
2.
Glennison M, Salloum C, Lim C, Lacaze L, Malek A, Enriquez A, et al. Accessory liver lobes: Anatomical description and clinical implications. J Visc Surg 2014;151:451-6.  Back to cited text no. 2
    
3.
Jones R, Tabbut M, Gramer D. Elongated left lobe of the liver mimicking a subcapsular hematoma of the spleen on the focused assessment with sonography for trauma exam. Am J Emerg Med 2014;32:814-e3.  Back to cited text no. 3
    
4.
Crivello MS, Peterson IM, Austin RM. Left lobe of the liver mimicking perisplenic collections. J Clin Ultrasound 1986;14:697–701.  Back to cited text no. 4
    


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