A 73 y.o. male presents with abdominal pain

What does the CT show?

Our patient had a hot quadrate sign.  This is a condition where there is enhancement of the quadrate lobe of the liver.  This occurs in situations where the SVC is occluded and collateral flow causes the quadrate to receive most of the contrast. On the images shown, there are extensive collaterals which occurs with svc occlusion. .  

another view of our patient with increased contrast in the quadrate lobe

the lobes of the liver are visualized here anteriorly and posteriorly.

Segment I is the caudates. It is posterior and superior. Segment IV posteriorly shows the quadrate lobe which is inferior and medial on the L lobe of the liver.

The caudate can also light up on CT scans if there is  a hepatic vein occlusion as in Budd Chiari syndrome.  The caudate shows more flow when the hepatic vein is obstructed because its drainage is to the inferior vena cava directly so it is unobstructed.

contrast in the caudate lobe with Budd Chiari syndrome

Our pt had a neg CT other than the SVC occlusion.

Birmani, V, Lal A, Ahuja C, Khandelwal N. The CT Quadrate lobe hot spot sign. Annals of Hepatology 2010. 9(3):296-8

Dickson A. The focal hepatic hot spot sign. Radiology 2005.  237(2):647-8.