Radiology: Left lobe hypertrophy

The physical examination can help make a diagnosis of cirrhosis.  The obvious findings like ascites, asterixis and palmar erythema are not always present, so the astute clinician must also be on the lookout for more subtle findings.

A cirrhotic liver can be either shrunken or enlarged, so the rostral-caudal span is not that helpful.  However! Cirrhotic livers frequently have left lobe hypertrophy.  This is detected below the xyphoid process/costal margin (midline of the abdomen).  So, a palpable liver edge there…combined with a high pretest probability of cirrhosis, can be very helpful. 

In the above image, note the extensive right-to-left span of the left lobe.  A liver this large should be palpable by physical exam. Happy hunting.

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