Radiology Teaching Files > Case 5021544

Contributed by: Arman Forouzannia.
Patient: 38 year old male
History: 38yo male with history of hemochromatosis complaining of vague abdominal pain.

Fig. 1: Hypoechoic lesion

Fig. 2: Fatty Liver

Fig. 3: Doppler flow

Fig. 4: Non contrast

Fig. 5: Arterial Phase

Fig. 6: Portal Venous Phase

Ultrasound demonstrates round area of hypoechoic change near the bifurcation of the portal vien.  No significant doppler abnormality. No cirrhotic changes were noted in the liver.

A 3 Phase liver CT demonstrated a geometric area of increased attenuation at the bifurcation of the portal vien on initial non contrast series.  HU measurements on preconstrast were similar to the spleen.  HU measurement on precontrast of remaining liver was diffuse low in the 20s.  Arterial and Venous phase imaging failed to demonstrate any abnormal enchancement pattern.  No mass effect was demonstrated.  No other suspicious findings noted. These are most consistent with an area of focal fat sparing superimposed on a fatty liver likely secondary to patients history of hemochromatosis. 

Diagnosis: Focal Fat Sparing in the Liver

The follwing can be causes for false positives in US evaluation of the liver on US:

Regenerative nodules
Dysplastic nodules
Focal fat
Fatty sparing.

Other nonmalignant hepatic neoplasms such as hemangioma may appear similar to HCCA, although arteriovenous (A-V) shunts are uncommon. Focal nodular hyperplasia and liver cell adenoma may have extensive A-V shunting, usually occurring more often in females.

Hepatocellular CA characteristically is a hyper-attenuating nodule noted on arterial phase imaging, with hyper- and/or hypo-attenuation developing on portal venous phase imaging.


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Additional Details:

Case Number: 5021544Last Updated: 06-08-2006
Anatomy: Gastrointestinal (GI)   Pathology: Benign Mass, Cyst
Modality: CT, USExam Date: Access Level: Readable by all users
Keywords: focal fat sparing steatohepatitis fatty liver

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