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Symptoms and Signs – Differential Diagnosis of Hepatomegaly, by Shape of Liver
DIFFUSELY ENLARGED AND SMOOTH
Massive
• Metastatic disease
• Alcoholic liver disease with fatty infiltration
• Myeloproliferative diseases (e.g., polycythemia rubra vera,
myelofibrosis)
Moderate
• The above causes
• Hemochromatosis
• Hematologic disease (e.g., chronic myeloid leukemia, lymphoma)
• Fatty liver (e.g., diabetes mellitus, obesity)
• Infiltrative disorders (e.g., amyloid)
Mild
• The above causes
• Hepatitis (viral, drugs)
• Cirrhosis
• Biliary obstruction
• Granulomatous disorders (e.g., sarcoid)
• HIV infection
DIFFUSELY ENLARGED AND IRREGULAR
• Metastatic disease
• Cirrhosis
• Hydatid disease
• Polycystic liver disease
LOCALIZED SWELLINGS
• Riedel’s lobe (a normal variant; the lobe may be palpable in the
right lumbar region)
• Metastasis
• Large simple hepatic cyst
• Hydatid cyst
• Hepatoma
• Liver abscess (e.g., amebic abscess)
DIFFUSELY ENLARGED AND SMOOTH
Massive
• Metastatic disease
• Alcoholic liver disease with fatty infiltration
• Myeloproliferative diseases (e.g., polycythemia rubra vera,
myelofibrosis)
Moderate
• The above causes
• Hemochromatosis
• Hematologic disease (e.g., chronic myeloid leukemia, lymphoma)
• Fatty liver (e.g., diabetes mellitus, obesity)
• Infiltrative disorders (e.g., amyloid)
Mild
• The above causes
• Hepatitis (viral, drugs)
• Cirrhosis
• Biliary obstruction
• Granulomatous disorders (e.g., sarcoid)
• HIV infection
DIFFUSELY ENLARGED AND IRREGULAR
• Metastatic disease
• Cirrhosis
• Hydatid disease
• Polycystic liver disease
LOCALIZED SWELLINGS
• Riedel’s lobe (a normal variant; the lobe may be palpable in the
right lumbar region)
• Metastasis
• Large simple hepatic cyst
• Hydatid cyst
• Hepatoma
• Liver abscess (e.g., amebic abscess)
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