Clinical Nuclear Medicine:
From the *Department of Radiology, Memorial Sloan-Kettering Cancer Center; and †Weill Cornell Medical College, New York, NY.
Received for publication February 6, 2012; revision accepted March 13, 2012.
Conflicts of interest and sources of funding: none declared.
Reprints: Gary A. Ulaner, MD, PhD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY 10065. E-mail: firstname.lastname@example.org.
Abstract: A 70-year-old man underwent partial gastrectomy with pathology demonstrating gastric follicular lymphoma. After surgery, a staging FDG PET/CT study demonstrated an FDG-avid low-attenuation band in the liver. Corresponding MRI demonstrated a high T2 signal abnormality. This was believed to represent liver parenchymal injury due to liver retraction during surgery. The patient was managed conservatively. MRI at 1 month of follow-up demonstrated resolution of the T2 signal abnormality. FDG PET/CT at 6 months of follow-up demonstrated resolution of FDG uptake. Tissue injury from surgical retraction can produce FDG-avid lesions that need to be distinguished from malignancy on PET/CT.
1. Lohlun J, Guirguis A, Wise L. Elevated liver enzymes following open roux-en-y gastric bypass for morbid obesity—does timing of liver retraction affect the rise in the levels of transaminases? Obes Surg. 2004; 14: 505–508.
2. Pasenau J, Mamazza J, Schlachta CM, et al.. Liver hematoma after laparoscopic Nissen fundoplication: a case report and review of retraction injuries. Surg Laparosc Endosc Percutan Tech. 2000; 10: 178–181.
3. Tamhankar AP, Kelly CJ, Jacob G. Retraction-related liver lobe necrosis after laparoscopic gastric surgery. JSLS. 2011; 15: 117–121.
4. Etoh T, Shiraishi N, Tajima M, et al.. Transient liver dysfunction after laparoscopic gastrectomy for gastric cancer patients. World J Surg. 2007; 31: 1116–1121.
5. Fusco MA, Scott TE, Paluzzi MW. Traction injury to the liver during laparoscopic cholecystectomy. Surg Laparosc Endosc. 1994; 4: 454–456.
6. Yoon GH, Dunn MD. Subcapsular hepatic hematoma: retraction injury during laparoscopic adrenalectomy. J Endourol. 2006; 20: 127–129.
7. Kinjo Y, Okabe H, Obama K, et al.. Elevation of liver function tests after laparoscopic gastrectomy using a Nathanson liver retractor. World J Surg. 2011; 35: 2730–2738.
8. Morris-Stiff G, Jones R, Mitchell S, et al.. Retraction transaminitis: an inevitable but benign complication of laparoscopic fundoplication. World J Surg. 2008; 32: 2650–2654.
9. Yassa NA, Peters JH. CT of focal hepatic injury due to surgical retractor. AJR Am J Roentgenol. 1996; 166: 599–602.
10. Hunter V, Reid MH. Computed tomography of liver trauma due to surgical retraction. J Comput Tomogr. 1983; 7: 381–384.
11. Earls JP, Krinsky GA, DeCorato DR. MR imaging of focal hepatic injury due to use of surgical retractors. AJR Am J Roentgenol. 1996; 167: 816–817.
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