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Cartilaginous compression of the liver – clinical and ultrasonographic aspects

Andrzej Smereczyński
Andrzej Smereczyński
 and 
Katarzyna Kołaczyk
Katarzyna Kołaczyk
   | Mar 30, 2018
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Article Category: research-article
Published Online: Mar 30, 2018
Page range: 9 - 15
Received: Jan 29, 2017
Accepted: Aug 08, 2017
DOI: https://doi.org/10.15557/jou.2018.0002
Keywords
© 2018 Katarzyna Kołaczyk published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

A scheme for the measurement of the musculocartilaginous complex in a patient in sitting position and with forward trunk flexion
A scheme for the measurement of the musculocartilaginous complex in a patient in sitting position and with forward trunk flexion

Fig. 2

A 20-year-old athlete examined in a supine position during free breathing. Right costal arch area. Legend: downwards arrows – the external oblique muscle; upwards arrows – the transverse abdominal muscle; asterisk – the internal oblique muscle; a diamond at the top of the figure – the external intercostal muscle; a diamond at the bottom of the figure – the internal intercostal muscle; c – costal cartilages, L – liver
A 20-year-old athlete examined in a supine position during free breathing. Right costal arch area. Legend: downwards arrows – the external oblique muscle; upwards arrows – the transverse abdominal muscle; asterisk – the internal oblique muscle; a diamond at the top of the figure – the external intercostal muscle; a diamond at the bottom of the figure – the internal intercostal muscle; c – costal cartilages, L – liver

Fig. 3

A 26-year-old female. A. Examination in supine position during free breathing: right costal arch area imagined with a 7–12 MHz linear transducer; legend: c – costal cartilages, downwards arrows – the external oblique muscle, upwards arrows – the transverse abdominal muscle, a diamond – the internal oblique muscle, L – liver. B. Examination in supine position: assessment of the musculocartilaginous complex in the dynamic evaluation during deep inhalation and exhalation – on exhalation, a thickening of the transverse abdominal muscle (upwards arrows) and the external oblique muscle (i) occurs, costal cartilages (c) move closer to each another; on inhalation, thinning of the transverse abdominal muscle (upwards arrows) occurs, the tone of the external intercostal muscle with reduced echogenicity increases (e); costal cartilages (c) move away from each other; L – liver. C. Examination in a sitting position and forward trunk flexion: musculocartilaginous compression of the liver is most pronounced in anterior trunk flexion; which is accompanied by costal cartilages being pulled dorsally
A 26-year-old female. A. Examination in supine position during free breathing: right costal arch area imagined with a 7–12 MHz linear transducer; legend: c – costal cartilages, downwards arrows – the external oblique muscle, upwards arrows – the transverse abdominal muscle, a diamond – the internal oblique muscle, L – liver. B. Examination in supine position: assessment of the musculocartilaginous complex in the dynamic evaluation during deep inhalation and exhalation – on exhalation, a thickening of the transverse abdominal muscle (upwards arrows) and the external oblique muscle (i) occurs, costal cartilages (c) move closer to each another; on inhalation, thinning of the transverse abdominal muscle (upwards arrows) occurs, the tone of the external intercostal muscle with reduced echogenicity increases (e); costal cartilages (c) move away from each other; L – liver. C. Examination in a sitting position and forward trunk flexion: musculocartilaginous compression of the liver is most pronounced in anterior trunk flexion; which is accompanied by costal cartilages being pulled dorsally

Fig. 4

A 46-year-old female examined using a 3–6 MHz convex transducer in a supine position during inhalation and exhalation. Minor musculocartilaginous compression of the liver occurs during exhalation; however, precise determination of musculocartilaginous components is not possible
A 46-year-old female examined using a 3–6 MHz convex transducer in a supine position during inhalation and exhalation. Minor musculocartilaginous compression of the liver occurs during exhalation; however, precise determination of musculocartilaginous components is not possible

Fig. 5

A. The musculocartilaginous complex with inhomogeneous echogenicity during inhalation and exhalation with distinct, moderate liver compression (arrows). B. Hypoechoic musculocartilaginous complex with clear liver compression during exhalation (arrows). C. Highly echogenic musculocartilaginous complex with clear liver compression (arrow)
A. The musculocartilaginous complex with inhomogeneous echogenicity during inhalation and exhalation with distinct, moderate liver compression (arrows). B. Hypoechoic musculocartilaginous complex with clear liver compression during exhalation (arrows). C. Highly echogenic musculocartilaginous complex with clear liver compression (arrow)

Fig. 6

Significantly deeper, focal musculocartilaginous compression of the liver (arrows)
Significantly deeper, focal musculocartilaginous compression of the liver (arrows)

Fig. 7

Very deep penetration of the costal arch (A) dividing the liver into two parts (L)
Very deep penetration of the costal arch (A) dividing the liver into two parts (L)

Fig. 8

A. Patient in supine position – hepatic compression by the musculocartilaginous complex is deeper during exhalation than inhalation. B. The same patient – in an upright sitting position on the left; in a sitting position with forward trunk flexion on the right – most pronounced hepatic compression
A. Patient in supine position – hepatic compression by the musculocartilaginous complex is deeper during exhalation than inhalation. B. The same patient – in an upright sitting position on the left; in a sitting position with forward trunk flexion on the right – most pronounced hepatic compression

Fig. 9

The cartilaginous tip of the xiphoid process (XP) compressing the left hepatic lobe (L)
The cartilaginous tip of the xiphoid process (XP) compressing the left hepatic lobe (L)

Fig. 10

Splenic compression (S) by the musculocartilaginous complex on the left (arrows) in a sitting position (left side of the figure) and forward trunk flexion (right side of the figure); G – stomach
Splenic compression (S) by the musculocartilaginous complex on the left (arrows) in a sitting position (left side of the figure) and forward trunk flexion (right side of the figure); G – stomach

Comparison of the thickness of the musculocartilaginous complex during inhalation, exhalation, supine position, sitting position and forward trunk flexion in 178 patients

Feature Thickness range Mean SD Feature Thickness range Mean SD
Inhalation 11–28 mm 14.5 mm +/− 2.4 Exhalation 12–40 mm 21.5 mm +/− 3.3
Sitting 11–31 mm 17.0 mm +/− 2.9 Flexion 20–40 mm 25.4 mm +/− 3.5

Ultrasonographic characteristics of the musculocartilaginous complex in 182 patients

Feature Number of patients Percentage
Heterogeneous 121 66.5
Hypoechoic 35 19.2
Hyperechoic 26 14.3
Smooth outline of indentation 182 100.0
Broad base of the costal arch 182 100.0
Focal costal compression 152 83.5
Segmental costal compression 30 16.5

Summary of statistical data on the thickness of the musculocartilaginous complex at different testing stages in 178 patients

Stage Mean Stage Mean
Inhalation 14.5 mm Exhalation 21.5 mm
Inhalation 14.5 mm Sitting 17.0 mm
Inhalation 14.5 mm Flexion 25.4 mm
Exhalation 21.5 mm Sitting 17.0 mm
Inhalation 21.5 mm Flexion 25.4 mm
Sitting 17.0 mm Flexion 25.4 mm
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