Presentation
Child-Pugh grade C cirrhosis secondary to ETOH.
Patient Data
The liver has a lobulated surface contour and diffusely heterogenous attenuation and enhancement, also with a relatively prominent caudate and left lobe compared to the right lobe. Multiple ill-defined somewhat confluent hypoattenuating nodules, clearly compressing the suprahepatic veins. There is an exophytic nodular mass within the segment VI, following the same pattern of the remainder ill-defined liver lesions. Perfusional disturbance within the peripheral portions of the segments II and VII. The portal vein has normal caliber and shows good contrast within. Prominent esophageal varices and a tortuous venous communication between the proximal main portal vein and the inferior vena cava.
The spleen, pancreas, and adrenal glands are normal. The small hypoattenuating lesion in the lower pole of the right kidney does not demonstrate prominent enhancement and is compatible with a high-density cyst (Bosniak II). The lung bases are clear.
Case Discussion
This patient has known cirrhosis and is still a heavy drinker. The CT images show hypoattenuating halos surrounding the portal tracts and relatively sparing the periphery of the liver. The low (negative HU) attenuation of these lesions and their predisposition of periportal zones involvement, in a drinker cirrhotic patient, favor the diagnosis of periportal fatty infiltration.
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