Focal fatty sparing

Case contributed by Hani Makky Al Salam
Diagnosis almost certain


Known case of psoriasis on corticosteroids having elevated liver function test.

Patient Data

Age: 25 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.


Liver US demonstrates diffuse increased echogenicity. The echogenic walls of the portal veins and hepatic veins are lost, due to the liver attenuation having increased. A small focal hypoechoic lesion is noted at segment 6. This most likely represents a focal fatty sparing in the background of diffuse hepatic steatosis. However, due to its atypical location further evaluation was recommended.


CT scan of the liver demonstrates diffuse reduction of hepatic attenuation. The segment 6 lesion appears hyperdense in all phases of enhancement. Unfortunately, a non-enhanced control scan was not taken, so whether this lesion is truly enhancing or it is hyperdense from the start can not be determined.


There is increased SI of the liver on T1 in phase sequence, the lesion is not well defined. However, on T1 out of phase sequence there is drop of the SI of the liver with segment 6 lesion becomes more conspicuous on background of fatty liver representing a focal fatty sparing of the liver.

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