Steatohepatitis - masslike steatosis


This case exemplifies how tricky nodular steatosis can be.

Ultrasound findings of diffuse diffusely increased echogenicity, coarse echotexture, and heterogeneous parenchyma suggest steatosis. CT findings of patchy liver hypoattenuation which approaches the density of macroscopic fat also suggest profound steatosis; note how the hepatic vessels are stereotypically preserved as they course through the regions steatosis. In addition, faint nodularity along the liver undersurface hints at a degree of hepatic fibrosis

The caudate lobe drew attention on both ultrasound and CT because it resembles a discrete mass, although in retrospect shares similar characteristics with adjacent steatotic liver. Patient initially underwent random liver biopsy to asses overall liver disease, and after further discussion went for biopsy of the caudate region to exclude malignancy. 

Thanks to Dr. Kevin Liu.