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Progressive fatty liver and hepatic cysts

Case contributed by Dr Chris O'Donnell

Presentation

Multiple renal calculi, laparoscopic gastric band in situ.

Patient Data

Age: 60 years
Gender: Male

Series of non-contrast CT liver from 2012 - 2018

CT

The liver has become progressively fatty with parenchymal HU densities reducing from 50 to 21 over the period of 2012 to 2018 (from left to right: 2012, 2013, 2015, 2017, 2018, and 2018).  As a result, cysts in the right hepatic lobe have become increasingly difficult to detect.

Case Discussion

One of the interpretation issues with fatty liver is the difficulty in detecting hypodense focal pathology and in this case, cysts in the right hepatic lobe posteriorly have become progressively difficult to visualize as there is loss of contrast difference between the 2, i.e. a 50 HU difference between parenchyma and cyst in 2012 down to <30 HU in 2017 and 2018.  Also of interest is the inexorable progress in fatty change over 6 years despite a laparoscopic gastric band in situ for weight reduction.

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