what does lobulated contour of the liver meanwhat does lobulated contour of the liver mean
Fig. 8600 Rockville Pike As you track across the abdomen, you will recognize the aorta and then the vena cava. This blind spot is shown schematically in Fig. What does lobulated contour and mild hyperechogenicity of both kidneys mean? 4.12). Copyright 2016 Elsevier Inc. All rights reserved. Invasive cancer means the cancer cells have broken out of the lobule where they began and have the potential to spread to the lymph nodes and other areas of the body. Hepatic metastases. The acquired irregularity of form is either the result of external influences, or it depends upon an affection of the tissue of the liver. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Dr. Clarence Grim answered. MeSH 4.18Two transverse sections of the left border of the liver: caudal (ca) in front and cranial (cr) behind. By varying the pressure on the transducer, you can keep the inferior border of the liver at the right edge of the image. Notice that the anterior portions of the right lobe are not visualized. Fig. The majority of hemangiomas with type-3 enhancement showed lobulated margins (83.5%) (P<.001). The third scanning approach to the liver is the one through the intercostal spaces. 4.4Demonstrating the inferior border of the liver. Recall that three basic scanning approaches are available: longitudinal (Fig. Press the caudal end of the transducer a bit more deeply into the abdominal wall than the cranial end, so that the scan is directed slightly upward. Fatty liver. As the transducer moves farther to the right, the angle of the inferior hepatic border becomes increasingly blunted (Fig. Lobulated contour was defined as an interface with the liver parenchyma composed by multiple small well-demarcated outpounchings. These masses may be benign genetic differences or a result of liver disease. Elastography can detect stiffness of the liver caused by liver fibrosis earlier than other imaging tests. Fig. Others in family likely have same thing. Solitary nonparasitic cysts. The Fig. Medications, such as antibiotics, may be prescribed in order to avoid infections as well as vaccinations for viral hepatitis. 4.14Superior border of the left lobe. Unlike healthy liver cells, scar tissue cells cannot self-repair or otherwise function. Formed from the amalgamation of the Greek word 'isos' which means 'equal' and the Latin word 'densus' which means 'thick'. or stones etc no worries. Doctors typically provide answers within 24 hours. Virtually, all hemangiomas>18mm show lobulated margins. The image is now dominated by a chaotic pattern of highly contrasting light and dark areas with no discernible shape, caused by the gas and liquid contents of the stomach. We need more data. A Cirrhosis is a permanently scarred and damaged liver. With a flat scanning angle, anterior portions of the liver are displayed on the left side of the screen. These simple anatomical facts are widely known, but they have special significance and implications for ultrasound scanning. Now ask the patient to take a deep breath, expanding the abdomen, and the liver will appear on the screen as a region of homogeneous echo texture. (n.d.). Which Cell Has More Mitochondria? After you have scanned across the inferior border of the liver once for orientation, make a second pass while giving attention to details. Sugimoto K, Moriyasu F, Saito K, Yoshiara H, Imai Y. Ultrasound Med Biol. Fig. Defining the superior border of the liver. WebLobulated means made up of lobules. 4.5The inferior border of this liver () is difficult to scan. The superior border of the liver is flat on the left side. This may be caused by overeating, alcohol abuse, hepatitis, diabetes mellitus, disorders of lipid metabolism, or medications. In the cranial section, the stomach (S) and heart (H) are displayed along with the liver. Note the relatively bright wall echoes. Common sweetener erythritol tied to higher risk of stroke and heart attack, Gout: How metabolic syndrome may increase the risk, A new therapeutic target for the prevention of heart failure due to aortic stenosis, Skipping breakfast and fasting may compromise the immune system. 4.37, 4.38), or they may be isoechoic or hyperechoic. Cirrhosis can be diagnosed by radiology testing such as computed tomography (CT), ultrasound or magnetic resonance imaging (MRI) or via a needle biopsy of the liver. We may assume a priori, and experience confirms the view, that the lobulation commences and is chiefly, if not exclusively, developed on the concave surface of the liver, as the natural point of departure for the fissures. After adjustment for 4.23). Follow a three-step routine for intercostal scanning: 2Slide the transducer along the ICS and repeat step 1. But as the scan is angled lower, the more posterior and inferior portions of the liver are displayed in transverse planes. 4.8Longitudinal serial scans of the inferior border. 4.33). Hypoechoic lesions in the liver can be difficult to interpret in some cases. Fig. 4.23Relative positions of the left and right hemidiaphragms. The test can be performed by ultrasound or MRI. This scale runs from 0 to 4: Using the BattsLudwig scale, the most advanced stage of fibrosis a person can have before developing cirrhosis is stage 3. Hepatic hemangiomas: difference in enhancement pattern on 3T MR imaging with gadobenate dimeglumine versus gadoxetate disodium. The kidney is OK but the spleen needs clarification. Some of the most common treatments involve: Scientists have yet to develop medications that directly reverse or treat the damage associated with liver fibrosis. With luck, the right kidney may also be seen. Healthcare providers can use several scales to define the stages of fibrosis. Please type your comment or suggestion into the text box below. Here, find out which problems can affect the liver and what treatment is, Hepatitis C can damage the liver and lead to cirrhosis, or scarring of the liver. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. sharing sensitive information, make sure youre on a federal Recall that in a longitudinal scan, the left side of the screen is cranial and the right side is caudal. WebThe lobulated liver is either a congenital abnormity or an acquired malformation. Various staging systems for assessment of fibrosis in chronic hepatitis. Is surgery necessary for a lobulated mass of 7 mm by 5 mm in kidney ? Pang G, Duan Z, Shao C, Zhao F, Zhong H, Shao G. Medicine (Baltimore). WebLobulated margination of liver hemangiomas: Is this a definitive feature? I have also had liver enzyme tests -- all normal. 4.4b, c). Cirrhosis (si-roh-sis) of the liver is caused by progressive scarring from liver inflammation. Relation to surroundings: expansile, infiltrating. 4.17b,c). They do this to assess the extent and type of damage. Note: we are unable to answer specific questions or offer individual medical advice or opinions. 4.37Hepatic metastases from breast carcinoma (). The most advanced type of fibrosis someone can have before developing cirrhosis, according to the Metavir system, is stage A3F3. The heart rests upon the diaphragm in this area. Moving from window to window, he views the center of the room several times and sees corners a total of five times. This can result in an enlarged spleen, ascitesand severe gastrointestinal (GI) bleeding from dilated blood vessels (called varices) that can rupture. The anterior surface of the liver, which lies against the abdominal wall, is flat and smooth. Scientists are also looking for better ways to treat certain causes of liver fibrosis, such as alcohol use or NASH. Also available from Amazon: A Manual of Pathological Anatomy. The latter are of peculiar interest, as the nature of the hepatic malformation, taken in connection with the increase or diminution of size, is characteristic of the internal affection of the viscus. MRI features of primary rare malignancies of the liver: A report from four university centres. But as the transducer is angled cephalad, the angle of the scan becomes more horizontal and this rule becomes less valid. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. This means that the liver is no longer able to carry out its various metabolic functions. (I have a lovely but stubborn Taurean baby daughter), Didn't find the answer you were looking for? The first step in defining the inferior and superior borders of the liver has already been taken: scanning across the organ in longitudinal sections, making one pass over the inferior portions and another over the superior portions (Figs. Mp = psoas muscle, N = kidney. The posterior surface is slightly concave in its lower portion and becomes slightly convex superiorly (Fig. Define the liver, and angle the transducer to sector the scan through the accessible liver segment (Fig. 4.20a), subcostal transverse or oblique (Fig. 3Move the transducer to the next intercostal space and repeat steps 1 and 2. It is almost always accompanied by a considerable diminution of size; the granulations and the atrophy generally commence at the edges, and the latter attains its extreme development at this point; the edges consequently appear very much thinned, and at last form a mere seam, consisting of cellulo-fibrous tissue, which is contained between two condensed laminae of peritoneum, and reflected over the convexity, or inverted into the concavity of the liver. Liver Ultrasound - Lobulated Hypoechoic Lesion. A tongue-like projection of the right lobe () extends down past the inferior pole of the kidney. Unable to load your collection due to an error, Unable to load your delegates due to an error. Damage to the liver may mean that a person needs to modify their, The liver has many roles, one being to make cholesterol while another is to remove excess amounts. For example, research has preliminarily shown the type 2 diabetes medication pioglitazone to improve NASH in people who do not have diabetes. Abnormalities and variants of the inferior border. Kupffer-phase findings of hepatic hemangiomas in contrast-enhanced ultrasound with sonazoid. The superior border of the liver is fiat on the left side and convex on the right side. Fig. Invasive lobular carcinoma is a type of breast cancer that begins in the milk-producing glands (lobules) of the breast. 4.17a) to triangular below (Fig. Fig. An example of data being processed may be a unique identifier stored in a cookie. Fig. In summary, the two figures show the following: As you scan down the hepatic left border, the liver is first imaged in anterior coronal sections. Survey the total liver volume in multiple planes. 4.31, 4.32). The majority of hemangiomas with type-3 enhancement show lobulated margins. Mar 28, 2019 6:14 AM. 2014 Jun;40(6):1089-95. doi: 10.1016/j.ultrasmedbio.2013.12.019. In most cases, a finding of heterogeneous liver is followed by further medical testing to determine the cause of the heterogeneity. Once a liver reaches a stage of cirrhosis, the damage is irreversible, and advanced stages can be fatal. Can astrology help parenting? As the transducer moves farther to the left, the cross section of the liver diminishes in size. Would you like email updates of new search results? 4.26Fatty liver. To evaluate the occurrence rate of lobulated margination of hepatic hemangiomas. Fig. When the increase of size is the result of congestion, or of temporary hyperaemic turgor, the liver retains the general outline of its normal condition: but if this affection becomes permanent, the vertical diameter soon predominates considerably. Notice the right angle formed by the anterior and diaphragmatic surfaces of the liver. Some of these remedies include: When a person has advanced liver fibrosis or cirrhosis, they often require additional forms of treatment, and liver damage is generally irreversible. Large foci of cellular alteration (LFCA) were lesions larger than a, The increased demand for oxygen, in turn, can lead to oxygen deficits at least in certain regions of the, These liver sections provided well-marked, Next, we examined the anatomical sites of FVIIIRAg immunoreaction within the, While these findings principally corroborate the studies of others reporting transformation of liver sinusoidal endothelium to FVIIIRAg-positive cells in advanced hepatic fibrotic disease of various causes [9, 10, 15-17], our study of aged cadavers with progressive stages of fibrosis also provides important data on the anatomical sites of FVIIIRAg expression as well as the histopathology of sinusoidal transformation to vascular endothelium within the, It is known that the pathogenesis of vascular endothelium in the, The findings suggest that, at these early stages of liver fibrosis, vessels within the, Further study has revealed differences in the extent of lesions among the, Acetaldehyde adducts are found predominantly in a certain region of the, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, A 2-year dose-response study of lesion sequences during hepatocellular carcinogenesis in the male B6C3[F.sub.1] mouse given the drinking water chemical dichloroacetic acid. A lobe is a well-defined portion of an organ or gland. A hypoechoic mass is tissue in the body thats more dense or solid than usual. 4.16. Parasitic cysts. This means that while performing serial scans, you will view many sections of the liver more than once but are apt to miss blind spots if you are not fully familiar with the extent of the organ. The scan planes are directed between adjacent ribs. Remember that the superior portions of the right lobe are a blind spot in the longitudinal liver survey. 4.40, 4.41). These include the Metavir, Ishak, and BattsLudwig scales. This condition is not accompanied by any perceptible shrivelling or condensation of the peritoneum in the fissures or sulci, and still less by a condensation of the parenchymatous cellular tissue, or an obliterated state of the vessels. WebFatty liver disease is a curable condition that occurs when fatty cells build up in the liver. Thus the liver is not unfrequently converted into a thick cake with rounded edges, if the inflammation has been uniform, or it may be converted into a globular mass, compressed into a small space by peritoneal investment, which, in consequence of repeated attacks of inflammation, is transformed into a fibrocartilaginous tissue. 4.36Echinococcus granulosus infection. Now scan down the left border by angling the transducer. Can You Guess The Country From The Picture? WebFig 1 - The cut surface of the liver reveals to the naked eye small,1.5 to 2 mm circular structures with a darker dot in the center and 4-5 darker dots at the periphery. Here are some related questions which you might be interested in reading. This term is used to describe what is seen on an ultrasound scan. The left border of the liver was already seen in the longitudinal sections of the superior and inferior borders. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. 4.4a). Results: Hyperaemic turgor, and still more all the varieties of hepatic infiltration, are distinguished by their producing a smooth surface. Notice how the shape of the liver section changes as the scan moves downward, changing from trapezoidal above (Fig. The posterior surface has several concavities that interrupt its triangular shape: the porta hepatis and the impressions from the gallbladder and right kidney. The echo pattern shows increased density. Intercostal scans are part of every upper abdominal ultrasound examination. Place the patient in the supine position and have him or her take a deep breath and hold it to expand the abdomen. This term is used to describe what is seen on an ultrasound scan. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. The differential diagnosis of echo-free hepatic lesions is reviewed in Table 4.1. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Federal government websites often end in .gov or .mil. Vessels are poorly delineated. It can be helpful to have the patient breathe in deeply and inflate the abdomen. Spiculated Repeat the longitudinal pass along the superior border of the liver, this time noticing the shape of the hepatic cross section. In the same manner as the granulations may produce a racemose appearance of the hepatic surface, they may, when several of them are grouped together, produce larger protuberances, or lobes; if the interstitial cellular tissue is much condensed, the peripheral groups may become pediculated, so as to resemble mere appendices. What Do Black Spots Seen On A Liver Ultrasound Mean? Two readers independently reviewed all cases. Why is it enlarged. Lifestyle changes including, diet changes such as a low-sodium or plant-based diet, and discontinuing the use of alcohol. What Happens When Cancer Spreads To The Lungs And Liver? A complete examination of the liver requires scanning from multiple angles and directions. With cirrhosis, regenerative nodules in the liver produce a lobulated contour (Fig. You can learn more about how we ensure our content is accurate and current by reading our. This scan corresponds to the section in Fig. 1 - These abnormities are either congenital, and are then in part foetal conditions of the liver, in part acquired. The pulsating heart can be seen cranially (left side of the image). WebRegenerative nodules are composed of benign liver tissue, closer to normal parenchyma than the fibrotic septations separating them. 4.28). Malformations of the liver must be considered in reference: Firstly, To the relation of the vertical to the longitudinal and transverse diameters, or the circumference of the edges; Secondly, To the condition of the edges, which may be bevelled off, thinned, acuminated, or thickened, enlarged, and rounded; Thirdly, To the state of the surface, which may be variously smooth and level, or as variously uneven. To make the liver more accessible, have the patient raise the right arm above the head to draw the rib cage upward. Lobulated margination; MRI; contour; liver hemangioma; size. This can occur due to a number of reasons which include: conditions that cause hepatic fibrosis 1 cirrhosis hemochromatosis various types of hepatitis 3 particularly chronic hepatitis conditions that cause cholestasis official website and that any information you provide is encrypted The liver may heal more slowly or quickly, depending on the cause of the fibrosis and its severity. Abdom Imaging. Even so, it is often not possible to define the full cross section of the liver on the left side of the screen, and a portion of the liver will appear cut off (Fig. The liver tapers inferiorly to a more or less sharp-angled border. 4.374.42). 4.13Demonstrating the superior border of the liver. 4.32Solitary hepatic cyst with compression of the right hepatic vein (). Dietrich CF, Mertens JC, Braden B, Schuessler G, Ott M, Ignee A. Hepatology. 4.27). I have this unexplained pain on my right side. The liver can be scanned in the same fashion from other probe placements (Figs. Focusing on the inflow of blood, the portal lobule is defined to be those cords of hepatocytes that drain blood from an individual portal venule. The posterior portions of the liver located farther from the transducer were already visualized through the subcostal approach. 2018 Sep;97(38):e12512. Press firmly with the transducer along the right costal arch so that you can scan beneath the ribs at a relatively flat angle. Symptoms can include: If your doctor suspects you have cirrhosis, one or more of the following imaging tests may be performed: While there is no cure for cirrhosis, your doctor may recommend various treatments to help slow the scarring and relieve symptoms. 4.17Scanning down the left border of the liver. Fig. Fig. Figure 4.8 illustrates a series of longitudinal sections of the inferior hepatic border obtained by scanning across the liver from left to right. These and similar scoring systems take into account the effect that the fibrosis has had on the portal vein, which delivers blood from the intestines to the liver. Elastography: This exam assesses the stiffness of your liver and can help diagnose how severe the scarring is in your liver (known as liver fibrosis). However, the condition tends not to cause noticeable symptoms until it has progressed. The enlargement of these protuberances appears to be encouraged by the additional labor thrown upon them, and still more so if these portions have become the seat of fatty and other infiltrations. They are characterized by a round or oval shape, smooth margins, a thin wall, no internal echoes, posterior acoustic enhancement, and lateral edge shadows (Figs. Mentally picture the liver lying beneath the ribs, and angle the scan upward. It's depends on the characteristics of the mass. 4.13). Fig. A liver transplant replaces the damaged liver with a healthy one from a donor. Semelka RC, Nimojan N, Chandana S, Ramalho M, Palmer SL, DeMulder D, Parada Villavicencio C, Woosley J, Garon BL, Jha RC, Miller FH, Altun E. Eur Radiol. Liver function test: This test involves analyzing the blood for particular. Figure 4.5 shows the appearance of a liver that is difficult to scan. Left untreated, liver fibrosis can eventually lead to cirrhosis of the liver which is not reversible. There are two types of liver lobule, which look at the same cluster of liver cells from opposite ends. The liver is the dominant organ of the right upper abdomen. These induce fibrous condensation of the parenchymatous cellular tissue, and cicatriform contraction of the investing peritoneum, beyond which the neighboring parenchyma projects in the shape of shallow, convex, and smooth protuberances, circumscribed by slight furrows. Then slide the transducer cranially and caudally within the same ICS and repeat the sectoring maneuver. To treat the symptoms of cirrhosis itself, your doctor may recommend: This page was reviewed on April, 15, 2022. Many findings can be adequately interpreted based on their ultrasound features, whereas others will require additional studies. The echo pattern of the liver is markedly denser than that of the kidney. CT and MRI of Hepatic Contour Abnormalities. Intrinsic disorders of the liver that may cause contour abnormalities consist of hepatic tumors, cirrhosis, infarction, and vascular occlusion; treatment change also may cause contour abnormalities. Perihepatic diseases also may cause extrinsic alteration of the liver contour. WebCancerous liver lesions include: Hepatocellular carcinoma, the most common form. Even in the varieties of atrophy of the liver, the remarks made as to the alterations of form, are confirmed in the main; in the yellow variety the liver is generally reduced in its vertical diameter, whereas in the red variety, the decrease is chiefly perceptible at the edges, and the vertical diameter consequently predominates; in the former case the organ presents a disk-like shape, in the latter that of a hemisphere or ball. Continue with Recommended Cookies. You can also hold the transducer in a slightly oblique position, parallel to the costal margin. Cox-North, P. P., & Shuhart, M. C. (2018). These lesions are clearly visible when approximately 5 mm or larger. Lobulated means made up of lobules. You can do this by varying the pressure on the transducer as needed. 4.9Fatty liver. One disadvantage of holding the breath is that it is followed by a period of hyperventilation, especially in older patients. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Even so, he is unable to see the man sitting in one corner of the room. Now slide the transducer to the left, keeping it in a longitudinal plane while following the line of the costal arch as closely as possible. Circumscribed changes in the liver parenchyma are often challenging for the sonographer. Please enable it to take advantage of the complete set of features! Blood work all came back normal, but Because the liver is so large, it is best to proceed in steps when learning how to scan the entire organ. Fig. WebThe meaning of LOBULATED is made up of or having lobules. What is a lobulated hypoechoic mass? If a person has several risk factors and suspects that they may have liver fibrosis, they should consult a doctor. Notice the blunted appearance of the hepatic border () in the anterior coronal section. We shall devote some further consideration to this class. HHS Vulnerability Disclosure, Help Learn more about the foods and drinks that are good for liver health here. Fig. WebWhat is nodular hepatic contour? Focusing on the outflow of blood, the classical lobule is composed of those cords of hepatocytes that drain blood into an individual hepatic venule. Notice the smooth, round margins, the echo-free cyst wall, the posterior acoustic enhancement, and the lateral edge shadows. Lobulated. Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/lobulated. The presence of hemorrhage or necrosis was also recorded. Many scales also measure the extent of fibrosis and the location or number of septa, which are fibrous bands of tissue in the biopsy sample. 4.4 were selected to illustrate good scanning conditions. Is Liverite Safe To Use With A Fatty Liver? Tateyama A, Fukukura Y, Takumi K, Shindo T, Kumagae Y, Kamimura K, Nakajo M. World J Gastroenterol. Notice that the anterior border cannot be adequately defined. "No free fluid" is also good news. CT scans can detect the additional fatty structures in the liver, which appear on the scan as areas of lighter-colored tissue, according to an article in The Oncologist. i do have back pain. Post the Definition of lobulated to Facebook, Share the Definition of lobulated on Twitter. Whereas the longitudinal liver sonography is done in parallel planes, subcostal scans are swept through the liver in a fan-shaped pattern. Its roughly triangular outline becomes progressively smaller and finally disappears. Rounded, hypoechoic, predominantly homogeneous metastasis without a halo. The irregularity of form consequent upon that textural disease which is called the granular liver, is very remarkable. You should get to know the liver in three dimensions. 4.16Scanning across the superior border of the liver. WebWhat does lobulated contour and mild hyperechogenicity of both kidneys mean? 4.30). Your doctor may treat your symptoms caused by cirrhosis by recommending lifestyle changes, medication, or transjugular intrahepatic portosystemic shunt (TIPS). Is the ketogenic diet right for autoimmune conditions? "Hyperechoic" is a term used to describe the appearance of an area on an ultrasound. When a circumscribed change is discovered in the liver, the examiner should systematically evaluate the following features: Echogenicity: echo-free, hypoechoic, isoechoic, echogenic, highly echogenic, posterior enhancement, shadowing. Regenerative nodules have MRI characteristics identical to those of normal liver, although the scarred and inflamed tissue in the remainder of the liver may have higher signal intensity on T1-weighted images and This evaluation was The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. The left lobe is easier to visualize because it is being scanned through the epigastrium and because the left hemidiaphragm is lower than the right (Fig. This can starve and eventually kill healthy liver cells, creating more scar tissue in the process. sharp pain low right pelvis, severe nausea. Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the Radiological Society of North America (RSNA) and the American College of Radiology (ACR), comprising physicians with expertise in several radiologic areas. What causes kidneys to become lobulated when they were not before? Nearly all liver cysts are benign (noncancerous). WebTo investigate whether hyperechogenicity of liver can reliably be interpreted as liver steatosis and if any concomitant or isolated fibrosis can be disclosed. Fig. It appears the next step would be to get a ct scan or MRI with contrast (if you can tolerate), as I am sure your physician or radiologist has already What type of MRI was acquired and discovered this finding? 322166814/www.reference.com/Reference_Desktop_Feed_Center6_728x90, The Best Benefits of HughesNet for the Home Internet User, How to Maximize Your HughesNet Internet Services, Get the Best AT&T Phone Plan for Your Family, Floor & Decor: How to Choose the Right Flooring for Your Budget, Choose the Perfect Floor & Decor Stone Flooring for Your Home, How to Find Athleta Clothing That Fits You, How to Dress for Maximum Comfort in Athleta Clothing, Update Your Homes Interior Design With Raymour and Flanigan, How to Find Raymour and Flanigan Home Office Furniture. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Four or five of these sweeps are necessary for a complete survey. An evident exception occurs when this condition takes place in early life, or when it is congenital. Multiple cysts are much less common (Fig. Riedels lobe is a tongue-like inferior projection of the right lobe that extends well past the lower pole of the kidney (Fig.
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