Presentation
Abdominal colic and epigastric pain
Patient Data
Ultrasound study shows irregular echogenic hepatic focal lesion.
CT study shows hepatic contour irregularity with an ill-defined hepatic area of altered density seen involving segment IV elicits low density in all phases with no enhancement.
Gallbladder stone and fundal adenomyosis are also noted
MRI study shows hepatic contour irregularity with an ill-defined geographic area of altered signal intensity seen involving segment IV. In T1 in-phase, it elicits intermediate to high signal intensity with a signal drop in T1 out-of-phase. In T2, this area elicits subtle high signal intensity. No enhancement in the post-contrast study. No associated mass effect with normal hepatic vessels seen coursing through this area without displacement
Gallbladder stone and fundal adenomyosis are also noted
Annotated images highlight the area of focal hepatic steatosis in all imaging modalities.
Case Discussion
Hepatic segment IV is a characteristic location for focal hepatic steatosis and focal fatty sparing. Geographic morphology, absence of mass effect, signal drop in T1 out-of-phase, and negative pathological enhancement, all are imaging features of focal hepatic steatosis differentiating it from other hepatic focal lesions.
Ultrasound images contribution by Dr. Shiamaa Hussien