CASE 1:
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Presentation
disease scene
Screening US (ultrasound)
screening by ultrasound
2. Patient Data
patient information
AGE: 65
GENDER: Male
3. Injury
A circumscribed area of increased echogenicity is visible in the liver, immediately anterior to the porta hepatis (segment IV).
A limited region of echogenicity is visible in the liver, just before the umbilical cord (segment IV).
The abnormality can be better appreciated on the cine recording.
Anomaly can be better assessed on recorded / recorded images.
6 month earlier exam
6 months before the screening visit.
The abnormality is essentially unchanged to the prior exam.
The abnormality was essentially unchanged from the last visit.
4. Case Discussion
Discuss the situation
Segment IV, immediately adjacent to the porta hepatis is the most common location for focal hepatic steatosis.
The IV lobe, immediately adjacent to the hepatic opening, is the most common site of focal fatty liver infection.
The ventral aspect of segment IV bordering the falciform ligament is another typical location, and commonly seen with cross-sectional imaging, but only occasionally with US. The likely explanation is that the superficial regions fall into the near field of convex transducers, where contrast resolution is significantly worse.
The front of the HPT IV adjacent to the sickle ligament is another typical site, and is often seen with cross-sectional imaging, but occasionally only on ultrasound. The possible explanation is that the surface areas fall into the near field of the curved probe, where the contrast resolution is significantly worse.
Focal fatty deposits showing the characteristic appearance and location can be followed with US, whilst for lesions showing atypical location or mass-like appearance, further evaluation with contrast-enhanced US is often warranted. CEUS can rule out malignancy with a specificity on par with cross-sectional imaging, is more cost-effective than MRI, and uses no ionizing radiation.
Focal fat deposits show characteristic shape and location that can be monitored by ultrasound, while for lesions that are atypical or have tumor-like characteristics, further evaluation is often required. Contrast-enhanced ultrasound (CEUS). CEUS can eliminate malignancies with a specificity equal to (equivalent) to cross-sectional imaging (generated from cross-sections), more cost-effective than MRI and does not use ionizing radiation.
5. Reference links: https://radiopaedia.org/cases/focal-hepatic-steatosis-2?lang=us
CASE 2:
1. Presentation
Incidental finding on imaging.
Random / random detection on images.
2. Injury:
CT demonstrates the presence of a low attenuation geographic lesion, with vessels coursing through without displacement.
Computed tomography revealed the presence of a low density mapping lesion, with blood vessels running through it without being pushed.
3. Case Discussion
Discuss the situation
Focal hepatic steatosis is often recognized by:
Local fatty liver is usually identified by:
- Location: peri-ligamentous, peri-portal
Location: around the ligaments, around the door
Distribution of lesions
- Presence of non-distorted, traversing blood vessels
Presence of passing / passing blood vessels and not deformed.
Despite this, patchy focal fat deposition and relative fatty sparing may be mistaken for a focal neoplasm (particular at US and CT) and thus MR in-phase and opposed-phase imaging allows reliable differentiation
However, uneven localized fat deposition and the associated non-fatty area can be mistaken for a local tumor (especially on ultrasound and computed tomography) and thus synchronous MRI and inverse phase for reliable distinctions.
4. Link reference: https://radiopaedia.org/cases/focal-hepatic-steatosis?lang=us
CASE 3
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Presentation
Right hypochondrial pain and dyspepsia. The patient is diabetic on oral drugs.
Lower right rib pain and indigestion. Patients with diabetes and taking oral medications.
2. Patient Data
AGE: 40 years old
GENDER: Female
3. Injury:
A lobulated geographic hypodense area is seen occupying most of the right lobe and the medial segment of left lobe with the blood vessels seen traversing this focal lesion without interruption. This lesion becomes less distinct in delayed images. No mass effect could be detected.
A map-like, polymorphic (consisting of lobes) desensitizing region was found to occupy the majority of the right lobe, and the middle segment of the left lobe with blood vessels was seen running through this focal lesion without interruption. This trauma becomes less apparent in late films. No block effect (Block effect not detected). Explain: Delayed images / scans: Late films (often called the hepatic parenchyma / portal vein late).
4. Link reference: https://radiopaedia.org/cases/focal-hepatic-steatosis-1?lang=us
CASE 4:
1. Presentation
Screening US.
2. Patient Data
AGE: 60 years
GENDER: Male
3. Injury:
A circumscribed area of geographic hyperechogenicity is visible near the porta hepatis – a fairly typical location for focal hepatic steatosis. A hepatic vein is traversing through this area uninterrupted, which is highly suggestive of fatty infiltration and is a strong indicator of non-mass like behavior.
4. Case Discussion
Discuss the situation
Absent vessel distortion is an important feature focal fatty infiltration and a benign behavior in general.
The absence of vascular deformation is an important feature of localized fatty infiltrates and a general benign (behavior /) trait.
5. Link reference: https://radiopaedia.org/cases/focal-hepatic-steatosis-absent-vessel-distortion?lang=us
Dr. VO HUONG – ANHVANYDS
