Riedel cloth

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Sketches from the original publication by Bernhard Riedel from 1888

The Riedel lobe is a tongue-like extension that does not normally occur on the anterior edge of the right lobe of the liver . It is not a separate flap in the anatomical sense, which is why it receives little attention in anatomical textbooks. This anomaly is named after Bernhard Riedel , who described a series of 7 such cases in 1888, most of which were related to the diagnosis of inflammation of the gallbladder .

Epidemiology

A wide range of about 3 to 30% is given for the frequency of occurrence of a Riedel flap. This can be interpreted as an indication that, on the one hand, it is not clearly defined from when one should speak of a Riedel flap in the event of a change in shape of the right lobe of the liver, and on the other hand, that different methods for diagnosis (only palpation and percussion or also imaging procedures ) are or have been available. A previously described, significantly more frequent occurrence in women was not confirmed in a more recent study, whereby the definition of what a Riedel flap is was very broad in this study ("liver extends downwards over the edge of the ribs").

meaning

In the times before the introduction of imaging procedures, the clinical examination with palpation of the abdomen for the diagnosis could not be supplemented with sonography , computed tomography , magnetic resonance tomography or nuclear medicine examination methods. Therefore, a mass palpable in the right upper abdomen could not be easily classified. Only when an operation was necessary could it be determined with certainty which organ or which structure corresponded to the palpable mass. It was therefore important to know the possibility of a palpable Riedel flap. Correspondingly, knowledge of the possible morphological variations at the anterior margin of the right lobe of the liver in the sense of a Riedel lobe is still helpful or necessary for the correct interpretation of the images in sonography, computed tomography and magnetic resonance tomography .

Often only a typical notch at the base of a Riedel flap is described. But there are also cases in which a relatively long Riedel flap with a narrow base has twisted, which naturally leads to acute clinical symptoms .

The question of whether a Riedel flap is a congenital anatomical variant or an acquired change in shape of the liver that is associated with an inflammation or other disease at the lower edge of the liver is discussed differently. Riedel himself described that the flap was no longer detectable after the acute illness (e.g. the gall bladder ) had ended. That would speak against an innate variant.

Web links

Commons : Riedel-Lappen  - collection of images, videos and audio files

Sources and literature

  1. ↑ a b c M. Kudo: Riedel's lobe of the liver and its clinical implication. In: Internal medicine. Volume 39, Number 2, February 2000, pp. 87-88, doi : 10.2169 / internalmedicine.39.87 , PMID 10732821 PDF (review).
  2. ↑ a b B. Riedel: On the tongue-shaped process of the right lobe of the liver and its pathognostic significance for the disease of the gallbladder together with remarks on gallstone operations , Berlin clinical weekly, 1888; 25: 577-602 Original from Internet Archive
  3. ↑ JH Gillard, MC Patel, PH Abrahams, AK Dixon: Riedel's lobe of the liver: fact or fiction? In: Clinical anatomy. Volume 11, Number 1, 1998, pp. 47-49, doi : 10.1002 / (SICI) 1098-2353 (1998) 11: 1 <47 :: AID-CA7> 3.0.CO; 2-P , PMID 9445097 .
  4. ↑ MS Elfeshawy: Bilobed spleen, transposition of the inferior vena cava and Riedel lobe: an extremely rare imaging finding in the same case. In: BJR case reports. Volume 5, number 2, June 2019, p. 20180091, doi : 10.1259 / bjrcr.20180091 , PMID 31501702 , PMC 6726177 (free full text).
  5. ↑ C. Lefaucher, E. Dupuis, J. Muller, A. Laham: [Torsion of Riedel's lobe. Two cases (author's transl)]. In: Journal de chirurgie. Volume 115, Number 1, January 1978, pp. 25-28, PMID 632329 .
  6. ↑ J. Champetier, R. Yver, C. Létoublon, B. Vigneau: A general review of anomalies of hepatic morphology and their clinical implications. In: Anatomia clinica. Volume 7, Number 4, 1985, pp. 285-299, doi : 10.1007 / BF01784645 , PMID 3833290 .
  7. ↑ C. Savopoulos, N. Kakaletsis, G. Kaiafa, F. Iliadis, A. Kalogera-Fountzila, AI Hatzitolios: Riedel's lobe of the liver: a case report. In: Medicine. Volume 94, number 3, January 2015, p. E430, doi : 10.1097 / MD.0000000000000430 , PMID 25621695 , PMC 4602636 (free full text).