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Anatomic Variations

Diaphragm, liver, spleen, pancreas, kidneys, adrenal glands and the GI tract can have numerous anatomic variants. Such findings on sectional imaging occasionally mimic pathologic conditions.

Muscular fibers of the diaphragm, which are primarily in the peripheral region, may invaginate into the adjacent sub-diaphragmatic fat in the upper abdomen and on CT scans or MRI, may be seen as soft tissue nodules (Fig. 4). Deeper diaphragmatic invaginations in the right side can result in accessory liver fissures, which are often seen in the superior aspect of the liver. In the posterior pararenal spaces, the lateral arcuate ligament of diaphragm may be seen as a soft tissue nodule. These diaphragmatic slips are more common in older persons, (nearly 70% frequency in patients older than 70 years, compared with 24% in younger patients) and are more prominent upon inspiration or in patients with emphysema. The diaphragmatic crura are ligamentous bands that are tendinous at origin. The right crus is longer and larger and often more lobular than the left side. On axial images of CT or MR, thickened areas of the crura can be mistaken for lymphadenopathy or even an adrenal nodule.

The caudate lobe of the liver may be divided in its inferior part into the medial papillary process and the lateral caudate process. If prominent, papillary process may appear similar to an enlarged node at the porta hepatis or simulates a mass in the head of the pancreas [1, 6]. It can extend medially behind the gastric antrum and is separated from the liver on at least one CT scan in about 20% of the patients. With MDCT, reconstruction of images in different planes will solve this issue. Pedunculated accessory hepatic lobe is a rare condition and can mimic an enlarged node or a pancreatic mass (Fig. 5).

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