Not hepatic infarction: Cold quadrate sign.

A 50-year-old male presented with bilateral lower extremity plain is found to have a wedge-shape hypodense region in the hepatic quadrate lobe. The hypoenhancement was thought to be a result of systemic-portal venous shunting due to IVC obstruction, a "cold" version of the classically described hot quadrate sign. Follow-up CT confirmed the diagnosis. Venous drainage pathway for both hot and cold quadrate signs is discussed. • The quadrate lobe of the liver (Couinaud segment IVb) is a place of frequent systemic-portal venous shunting. • In hot quadrate lobe sign, early contrast opacification occurs via internal thoracic and umbilical vein flow. • Wash in of non-opacified blood via epigastric and umbilical veins may cause "cold quadrate lobe sign" in IVC obstruction. [ABSTRACT FROM AUTHOR]