Liver Lesions With Hepatic Capsular Retraction

Retraction of the liver capsule may be associated with a diverse spectrum of benign and malignant etiologies. The more common causes include focal confluent fibrosis in cirrhotic livers, cholangiocarcinoma, and treated liver tumors, such as hepatocellular carcinoma, metastases, and lymphoma. Less common etiologies include primary sclerosing cholangitis, epithelioid hemangioendothelioma, hepatic hemangioma, solitary fibrous tumor of the liver, and hepatic inflammatory pseudotumor. Hepatic capsular retraction may also result from iatrogenic and noniatrogenic trauma. Due to the diversity and different nature of the various etiologies associated with this sign, it is important that radiologists be familiar with the characteristic features of these abnormalities, to avoid misdiagnosis that may adversely affect the therapeutic approach. It is also important to know that, contrary to some reports, hepatic capsular retraction is not a sign of malignant disease. The purpose of this article is to familiarize readers with the spectrum of benign and malignant etiologies of this sign and to point out additional computed tomographic findings that may allow confident diagnosis of the specific hepatic lesion responsible for the capsular retraction. The hepatic capsular and subcapsular regions may be affected by focal or diffuse pathologies affecting the liver. This hepatic area is more prone to be involved in various malignant and benign diseases due to several factors: the negative subdiaphragmatic pressure that may draw infected material and malignant cells toward the diaphragm, the perihepatic ligaments connecting the liver capsule with adjacent viscera, forming a direct root of dissemination, and the systemic blood inflow that supplies this region in addition to the portal and hepatic arterial blood flow. This is the reason for the multiple pathologic conditions and pseudolesions that occur at the hepatic capsular and subcapsular regions.