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Hot Quadrate Lobe Sign

Last Updated on August 14, 2020

Hot quadrate lobe sign focal hepatic hot spot in SVC obstruction on CT
Hot quadrate lobe sign focal hepatic hot spot in SVC obstruction on CT

What is the hot quadrate lobe sign?

The hot quadrate lobe sign is used to describe the intense arterial enhancement of the quadrate lobe of the liver on CT or MRI, seen in cases of SVC obstruction due to collateral circulation.

  • Also known as focal hepatic hot spot sign due to its appearance on technetium 99m sulphur colloid scans.
  • Pathophysiology : SVC obstruction -> if partial -> drainage by collateral vessels -> internal thoracic, superficial thoraco-abdominal veins and paraumbilical veins -> left portal vein-> Early arterial enhancement in the QUADRATE lobe of liver -> Hot Quadrate lobe sign on early arterial CT study.
  • This region is normally drained by the superior vein of S__P_Y (Watch the video for the answer!).
  • Only seen on ARTERIAL phase.
  • Clinical significance:
    • Suggests long standing SVC obstruction.
    • Cause of hepatic pseudo-lesion.
  • Differentials: Focal nodular hyperplasia, hepatocellular adenoma, HCC, hemangioma.
  • Hot Caudate lobe sign is seen in ⁉️ (Answer in the comments section!)

Detailed video with PACS based case images:

Focal Hepatic Hot Spot Sign
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Dr. Amar Udare, MD

Dr. Amar Udare has completed medical school from KEM Hospital Mumbai and radiology residency from Tata Memorial Hospital, Mumbai. He is a board-certified radiologist.

He has also completed fellowships in body imaging from Mumbai and Ottawa and is currently pursuing a fellowship in cross-section imaging at McMaster University, Canada.

He has a passion for teaching and his area of interest is body imaging. He started the website, RadioGyan to share radiology resources and cases to help residents and radiologists (#FOAMrad #radiology). He was a semi-finalist for the 2018 and 2020 Aunt-Minnie Most effective Radiology Educator Award.

You can read my most recent publications on: PubMed and Google Scholar

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