Figure 1
Axial CT image of the liver
Clinical History
Four hyperechoic liver lesions were detected in this asymptomatic patient with a history of obesity, diabetes mellitus type 2 and hypertriglyceridaemia. Further exploration of these lesions was performed with multislice helical CT.
Imaging Findings
On a check-up ultrasound examination, four hyperechoic liver lesions were detected in this asymptomatic patient with a history of obesity, diabetes mellitus type 2 and hypertriglyceridaemia. Further exploration of these lesions was performed with multislice helical CT. A follow-up multislice helical CT examination was performed four months later.
Discussion
Fatty metamorphosis of the liver is the result of excessive triglyceride deposition in the hepatocytes. The most common predisposing conditions are alcohol abuse, obesity, hyperlipidaemia, diabetes mellitus, exogenous steroid use, pregnancy, malnutrition, Cushing's disease, cirrhosis and chemotherapy [1,5].
Focal fatty metamorphosis may present diagnostic difficulties. Focal fatty metamorphosis generally does not displace any adjacent portal and hepatic vein branches, it appears as a hyperechoic area on ultrasonography, it generally has a non-spherical or infiltrative shape and generally it is poorly marginated [2,5]. Focal fatty metamorphosis has to be differentiated from other solid lesions, as it can have attenuation values in a similar range to other solid liver lesions [2]. Furthermore, focal fatty metamorphosis and other solid lesions (primary hepatic neoplasms, metastases, abscesses, haemangiomas, lipomas, angiomyolipomas, etc) may coexist [1-4].
If a delay in diagnosis is acceptable, a repeat CT examination may show rapid resolution or change in appearance with or without treatment of the underlying pathogenic condition [5]. Otherwise imaging with other modalities such as MRI is needed.
Differential Diagnosis List
Multifocal fatty liver metamorphosis.
Final Diagnosis
Multifocal fatty liver metamorphosis.
References
[1]
Flournoy J, Potter J, Sullivan B, Gerza C, Ramzy I. CT appearance of multifocal hepatic steatosis.
J Comput Assist Tomogr. 1984;8:1192-94. (PMID: 6501632)
[2]
Halvorsen R, Korobkin M, Ram P, Thompson W. CT appearance of focal fatty infiltration of the liver.
AJR. 1982;139:277-81. (PMID: 6979879)
[3]
Rich H. Resolution of focal fatty infiltration of the liver.
South Med J. 1996;89:1024-27. (PMID: 8865804)
[4]
Yoshikawa J, Matsui O, Takashima T, Ida M, Takanaka T, Kawamura I, Kakuda K, Miyata S. Fatty metamorphosis in hepatocellular carcinoma: radiologic features in 10 cases.
AJR. 1988;151:717-20. (PMID: 2844071)
[5]
Kawashima A, Suehiro S, Murayama S, Russell W. Focal fatty infiltration of the liver mimicking a tumor: sonographic and CT features.
J Comput Assist Tomogr. 1986;10:329-31. (PMID: 3512639)
Case information
| URL: | https://www.eurorad.org/case/1265 |
| DOI: | 10.1594/EURORAD/CASE.1265 |
| ISSN: | 1563-4086 |
