Geographic steatosis mimicking a mass

Case contributed by Jayanth Keshavamurthy
Diagnosis certain

Presentation

Ultrasound performed for mildly elevated liver enzymes.

Patient Data

Age: 65 years
Gender: Male
ultrasound
Transverse
Transverse
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Info

Irregular area of hypoechogenicity in the liver without mass effect, likely geographic steatosis.. Recommend MRI for confirmation.

Axial T1
in-phase
Axial T1
out-of-phase
Axial
DWI
Axial
T2
Axial T1
C+ fat sat
Axial T1
C+ fat sat
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Info

MRI confirms the sonogram findings of no mass effect and focal fatty sparing appearing as a pseudolesion.

Case Discussion

Look for mass effect and any vascular compromise when viewing a sonogram for lesion vs pseudolesion. MRI is useful to assess whether there is truly a mass or mass effect. In this case, the patient can be told to undertake lifestyle changes for steatosis and that no further workup is necessary.

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