A 12-year-old Pembroke Welsh Corgi experienced a serious health crisis after months of lethargy and loss of appetite, culminating in a collapse at home. Veterinarians later diagnosed her with torsion of the left medial liver lobe, a rare condition that disrupts blood supply due to the rotation of the liver lobe around its vascular pedicle. This case was notable for the presence of hepatocellular carcinoma, a primary liver cancer, situated uniquely at the base of the tumor instead of the expected location at the lobe's hilus. This configuration has not been previously documented in veterinary medicine.
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Liver lobe torsion is a rare but critical emergency that can lead to fatal complications. When a liver lobe twists, it blocks venous outflow, causing congestion and potential tissue death. Symptoms are often vague, including lethargy, vomiting, abdominal pain, and sudden collapse, which can mimic various other diseases. Typically seen in medium to large breed dogs, this condition can also affect smaller breeds or puppies, emphasizing the need for vigilance in diagnosis.
Upon arrival at the veterinary hospital, the Corgi was observed to be dull, with mild abdominal discomfort. Her vital signs indicated concerning elevations: a heart rate of 140 beats per minute and a temperature of 38.0 degrees Celsius. Blood tests revealed dramatically high levels of liver enzymes and inflammatory markers, indicating significant liver injury. Imaging studies showed a large mass in the abdomen that pushed adjacent organs out of alignment, with ultrasound revealing no blood flow within it, indicating possible vascular compromise.
A computed tomography (CT) scan was utilized, producing conclusive evidence of a 7.2 × 6.7 × 6.5 cm hepatic mass containing a whirl sign at its base. This appearance suggested torsion associated with a twisted vascular pedicle, a key hallmark in diagnosing this condition. The combination of imaging findings guided the surgical team in preparing for intervention.
The surgical procedure involved a midline celiotomy and was performed after the dog was medically stabilized. The affected liver lobe exhibited signs of severe congestion and necrosis. Importantly, the surgical team opted to remove the lobe without untwisting it to minimize the risk of toxic release from the damaged tissue. Post-surgery, histopathologic analysis confirmed the presence of hepatocellular carcinoma with extensive necrosis.
The recovery process was promising. The dog resumed eating the day after surgery and was discharged four days later. At a follow-up two weeks post-operation, she showed significant improvement, with all liver enzymes trending toward normality and no signs of metastasis. After a year, the dog's weight had increased by 10%, her energy levels had improved, and there were no indications of tumor recurrence.
Although this report details an individual case, it raises important considerations regarding the potential links between liver lobe torsion and hepatocellular carcinoma, particularly in older dogs. It suggests the necessity for surgical intervention even in cases with concurrent cancer when feasible, and highlights the effectiveness of CT imaging in diagnosing complex abdominal conditions.