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Focal fatty sparing of the liver

Case contributed by Varun Babu
Diagnosis almost certain

Presentation

Deranged liver function tests, came for ultrasound which picked up fatty infiltration of liver. MRI to rule out any underlying mass lesions.

Patient Data

Age: 40 years
Gender: Female

Mild enlarged liver with significant areas of signal drop out in out of phase T1 imaging predominantly in posterior segment 7 and segment 1. The areas demonstrating such signal loss show normal traversing intrahepatic vasculature. No local diffusion restriction. 

Case Discussion

Take home points from this study:

  1. in a fatty liver, give priority to fatty sparing early in your differentials. It is more common than a diffuse infiltrating neoplasm. 
  2. understand why fatty sparing or infiltration occurs. Alterations in venous drainage and blood insulin concentration levels are the two common theories underlying the differential fatty distribution of liver. Refer the article below for more details. 

 

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