Hepatomegaly

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Hepatomegaly refers to an increase in size or enlargement of the liver.

Pathology

Aetiology

Hepatomegaly can result from a vast range of pathology including, but not limited to, the following:

malignancy/cellular infiltrate
- multiple metastases
- lymphoma(s)
- leukaemia(s)
- hepatocellular carcinoma
- extramedullary haematopoiesis
- systemic mastocytosis
- angiosarcoma
acquired hepatic conditions
- fatty infiltration
- cirrhosis - early
- secondary haemochromatosis
- hepatic amyloidosis
- hepatic veno-occlusive disease
- sarcoidosis
- infectious mononucleosis
- acute hepatitis
- primary biliary cirrhosis
- hepatic tuberculosis ³
- histoplasmosis ³
acquired non-hepatic conditions
- right heart failure
congenital anomalies
- biochemical
  - glycogen storage disease
  - primary haemochromatosis
  - Gaucher disease
  - certain mucopolysaccharidoses - e.g. Hunter syndrome
  - Niemann-Pick disease
  - Wilson disease ³
  - chronic granulomatous disease of childhood ³
  - Weber-Christian disease ⁴
  - galactosemia ³
- anatomical
  - biliary atresia
syndromes
- Zellweger syndrome

Radiographic features

Assessment of liver size is commonly made on ultrasound or CT, although gross hepatomegaly may be apparent on abdominal radiograph.

For the adult liver:

midclavicular line averages 10-12.5 cm in craniocaudal length ²
- a liver that is longer than 15.5-16 cm in the midclavicular line (MCL) is considered enlarged
average transverse diameter is 20-23 cm at the level of the upper pole of the right kidney ²

In practice, however, assessment is often subjective.

Features that support hepatomegaly include ¹:

extension of the right lobe inferior to the lower pole of the right kidney
rounding of the hepatic inferior border

Differential diagnosis

Riedel lobe (normal variant)

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