Hepatomegaly can also be indicated when what occurs?

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When the liver enlarges enough to push its right lobe below the lower pole of the right kidney, it serves as a clear radiologic sign of hepatomegaly. The kidney provides a stable anatomical landmark, so the inferior extension of the right lobe below its pole reflects excess liver size rather than normal variation. Enlargement of the left lobe alone isn’t as reliable a marker on standard imaging; a dilated portal vein points to portal hypertension rather than purely increased liver size; and liver shifting can occur for reasons like mass effect or diaphragmatic changes. Hence, the downward extension of the right lobe below the right kidney is the best indicator of hepatomegaly.