Lobulated Hepatic Contour: Differential Diagnosis

Coarse hepatic lobulation

• Cirrhosis: Small liver with relative hypertrophy of the left and caudate lobes and signs of portal hypertension.
• Chronic Budd-Chiari syndrome: Look for hepatic vein thrombosis.
• Chronic portal vein thrombosis:
• Pseudomyxoma peritonei: Look for additional foci of implants.

Fine hepatic lobulation

• Cirrhosis: Small liver with relative hypertrophy of the left and caudate lobes and signs of portal hypertension.
• Pseudocirrhosis of treated breast cancer metastases to the liver: Specific to breast cancer. May also see multifocal retraction of the liver capsule, enlargement of the caudate lobe, and features of portal hypertension.
• Fulminant hepatic failure: Alternating areas of regenerative nodules and necrosis can give a nodular contour.
• Miliary metastases: Lobulated contour is a rare manifestation of miliary metastases.
• Sarcoidosis: Uncommon presentation of hepatic sarcoidosis may include diffuse granular heterogeneity and fine nodular contour.

References

Jha P, Poder L, Wang ZJ, Westphalen AC, Yeh BM, Coakley FV. Radiologic mimics of cirrhosis. AJR Am J Roentgenol. 2010 Apr;194(4):993-9.