Rare Liver Torsion Tied to Tumor Saved a Corgi’s Life

A 12-year-old Pembroke Welsh Corgi collapsed at home after months of creeping lethargy and loss of appetite, and what veterinarians found inside her abdomen turned out to be a combination so unusual that it has now been documented in a case report published in Veterinary Medicine and Science. The dog was suffering from torsion of the left medial liver lobe, a rare condition in which a hepatic lobe rotates around its vascular pedicle, cutting off its own blood supply. What made the case extraordinary was the discovery that the twist was associated with hepatocellular carcinoma, a primary liver cancer, positioned at the base of the tumor rather than at the lobe’s hilus, a configuration the authors say has not previously been described in veterinary medicine.

Liver lobe torsion is an uncommon but potentially lethal emergency in dogs. When a lobe twists, venous outflow is obstructed first, leading to congestion, thrombosis, and eventually ischemic necrosis of the tissue. If definitive treatment is delayed, the cascade can progress to peritoneal effusion, shock, sepsis, and death. Most of what veterinarians know about the condition comes from individual case reports and small retrospective series, because large-scale data simply do not exist. The clinical signs are frustratingly nonspecific: lethargy, anorexia, vomiting, abdominal pain, increased thirst and urination, fluid in the abdomen, and acute collapse can all point to many different diseases. Classically, medium- to large-breed, middle-aged to older dogs are overrepresented, and the left lateral lobe is the most commonly affected, presumably because of its size, mobility, and relative anatomical separation from adjacent lobes. But cases in small breeds and even puppies have been reported, meaning signalment alone should never rule the condition out.

When the Corgi arrived at the hospital, she was dull and showed mild abdominal pain. Her rectal temperature was 38.0 degrees Celsius, her heart rate was elevated at 140 beats per minute, and her non-invasive systolic blood pressure measured 90 mmHg. Bloodwork told a striking story: alanine aminotransferase, an enzyme released by damaged liver cells, was markedly elevated at 1228 U/L against a reference interval of 10 to 125. Aspartate aminotransferase reached 248 U/L, C-reactive protein, a marker of systemic inflammation, was six times the upper limit of normal at 6.0 mg/dL, and platelets were elevated at 678 × 10³/µL, a finding consistent with an inflammatory response. Mild increases in total protein and globulin rounded out a picture of significant hepatic injury and inflammation.

Abdominal radiographs revealed a large, well-defined mass in the cranial abdomen that was displacing adjacent organs caudally. Ultrasonography identified an approximately 7 cm mass between the left aspect of the liver and the spleen, along with a small volume of anechoic peritoneal effusion. Critically, color Doppler imaging detected no blood-flow signal within the mass, a red flag for vascular compromise. However, ultrasound alone could not definitively establish the diagnosis. That task fell to computed tomography, which proved to be the decisive diagnostic tool. The CT scan identified a 7.2 × 6.7 × 6.5 cm hepatic mass with a whirl sign at its base, the characteristic swirling appearance created by a twisted vascular pedicle. On the multiplanar portal venous-phase dataset, the twisted pedicle could be traced continuously to the portal venous branch supplying the left medial liver lobe. The mass also contained a non-enhancing hypoattenuating region measuring 15 to 22 Hounsfield units, consistent with necrosis secondary to vascular obstruction.

The whirl sign deserves particular attention because it is considered highly supportive of torsion when present, yet it can be missed or unobtainable with standard radiography and ultrasonography. In a comparative report of ultrasonographic and CT findings in dogs with liver lobe torsion, ultrasonography was suggestive of the condition in only one of five cases, whereas CT was fundamental for presurgical diagnosis in all of them. The present case reinforces that pattern: conventional imaging identified a mass and effusion but did not establish the torsion, while CT demonstrated the affected lobe, the necrotic non-enhancing parenchyma, and the whirl sign all at once. For atypical presentations, especially those complicated by a large hepatic mass or a peripheral torsion site, the authors argue that CT should be the modality of choice when liver lobe torsion is suspected.

Surgery proceeded after medical stabilization. The dog was premedicated with midazolam and fentanyl, anesthetized with propofol, and maintained on isoflurane with a fentanyl constant rate infusion, with perioperative dopamine, lactated Ringer’s solution, and the protease inhibitor nafamostat mesilate administered as needed. A midline celiotomy exposed a torsed left medial liver lobe that was dark and congested with partially pale-yellow areas, the gross signature of venous obstruction and ischemic necrosis. The rotation was identified as clockwise at the base of the mass. Importantly, the surgical team resected the lobe without detorsion, a deliberate choice designed to reduce the risk of thromboembolism and the systemic release of toxic metabolites from the ischemic tissue. The pedicle was double ligated proximal to the torsed site with monofilament polyglyconate suture and transected, and the remaining hepatic parenchyma near the hilus showed no gross evidence of neoplasia.

Histopathology delivered the second surprise. The resected tissue, fixed in formalin, embedded in paraffin, sectioned at 4 micrometers, and stained with hematoxylin and eosin, confirmed hepatocellular carcinoma with extensive necrosis. Neoplastic hepatocytes were arranged in irregular cord-like to solid patterns, and normal portal triad structures were absent within the lesion. The surgical margin was free of neoplastic cells, and the adherent falciform ligament contained only localized granulation tissue without malignancy. Fluid collected from the abdomen during surgery was classified as a culture-negative inflammatory exudate, likely related to hepatic necrosis or tumor-associated inflammation. The combination of a torsed lobe and a malignant tumor at the twist point raised an intriguing mechanical hypothesis: a large exophytic or pedunculated mass may alter weight distribution and increase rotational mobility of the lobe, creating conditions favorable to torsion.

Comparable phenomena have been documented in human medicine, though not identically. Pedunculated hepatocellular carcinomas and hepatic hemangiomas have been reported to twist around their vascular stalks in people, presenting as acute abdominal emergencies requiring surgical resection. These reports lend plausibility to the idea that a bulky, mobile tumor can act as a mechanical fulcrum. However, the authors are careful to note that such reports do not establish a common mechanism, and a causal relationship between hepatocellular carcinoma and liver lobe torsion cannot be determined from a single case. Prior veterinary literature offers only scattered precedents: a cat with right medial torsion and concurrent hemoabdomen from a ruptured hepatocellular carcinoma, one dog among a retrospective series of massive hepatocellular carcinomas with torsion of a neoplastic left lateral lobe, and a case associated with hepatic hemangiosarcoma. What distinguishes the Corgi is the location of the rotational axis at the base of the tumor, distal to the lobar hilus, with the proximal hepatic parenchyma entirely free of tumor.

The outcome was remarkably good. The dog recovered from anesthesia without incident, resumed voluntary food intake the day after surgery, and was discharged on postoperative Day 4 with an active suction drain removed on Day 3 after output fell below 1 mL/kg/day. No major complications, including hemorrhage, thrombosis, pancreatitis, or sepsis, occurred. At the two-week recheck, the preoperative lethargy, inappetence, and abdominal pain had resolved, and liver enzymes and inflammatory markers were falling, though still above reference intervals. By one year, the dog had gained 10 percent body weight, her activity level had markedly improved, and ALT, AST, ALP, and C-reactive protein had all normalized, with only platelets slightly elevated. Thoracic radiography and abdominal ultrasonography showed no evidence of recurrence or metastasis, and she maintained an excellent quality of life.

The report carries honest limitations. It describes a single dog, so the role of hepatocellular carcinoma as a predisposing factor for torsion remains speculative. Hepatic tissue proximal to the torsion was not examined histologically, immunohistochemistry was not performed, and follow-up imaging did not include CT, meaning subclinical recurrence or distant metastasis cannot be entirely excluded. Larger case series would be needed to determine whether primary hepatic neoplasia is a true risk factor. Nevertheless, the clinical lessons are clear and actionable. Liver lobe torsion can occur in small, geriatric patients, and concurrent cancer and advanced age should not automatically preclude surgery when complete resection appears feasible and perioperative stabilization can be achieved. For veterinarians facing a cranial abdominal mass with absent Doppler flow, the whirl sign on CT may be the key that unlocks a definitive preoperative diagnosis and a curative surgical plan, as it was for this resilient Corgi.

Subject of Research: Liver lobe torsion associated with hepatocellular carcinoma in a dog

Article Title: Left Medial Liver Lobe Torsion Associated With Hepatocellular Carcinoma in a Pembroke Welsh Corgi: A Case Report

Article References: Shinoda, H., Mori, K., Mori, H., Ishigaki, K., & Asano, K. (2026). Left Medial Liver Lobe Torsion Associated With Hepatocellular Carcinoma in a Pembroke Welsh Corgi: A Case Report. Veterinary Medicine and Science, 12(6), Article e71261. https://doi.org/10.1002/vms3.71261

Image Credits: AI Generated

DOI: 10.1002/vms3.71261

Keywords: liver lobe torsion, hepatocellular carcinoma, veterinary medicine, computed tomography, whirl sign, Pembroke Welsh Corgi, liver lobectomy, canine oncology, ischemic necrosis, case report, surgical treatment, small animal surgery