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Case Reports
. 2015 Nov 6;5(3):399.
doi: 10.2484/rcr.v5i3.399. eCollection 2010.

Multiple echogenic liver masses from multifocal nodular steatosis in a 55-year-old male with chronic hepatitis C

Christopher Ingraham, Puneet Bhargava, Jeffrey Otjen, Jonathan R Medverd, Sandeep Vaidya
Case Reports

Multiple echogenic liver masses from multifocal nodular steatosis in a 55-year-old male with chronic hepatitis C

Christopher Ingraham et al. Radiol Case Rep. .

Abstract

Hepatic steatosis is often seen in patients with hepatitis on screening ultrasound as generalized increased liver echogenecity. However, its nodular form can present as multiple echogenic masses, which can mimic hepatocellular carcinoma or metastasis by ultrasound and computed tomography. Small hepatocellular carcinomas are often hyperechoic and have a trend towards lower alpha-fetoprotein levels. Magnetic resonance imaging can accurately identify microscopic fat within the lesions and demonstrate lack of associated enhancing soft tissue. If this entity is not appropriately characterized using magnetic resonance imaging, it can lead to additional imaging workup and unnecessary biopsy.

Keywords: AFP, alpha-fetoprotein; AML, angiomyolipoma; CT, computed tomography; FNH, focal nodular hyperplasia; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging; US, ultrasound.

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Figures

Figure 1
Figure 1
A 55-year-old man with chronic hepatitis C and multifocal nodular steatosis. US shows multiple focal hyperechoic hepatic masses.
Figure 2, A-D
Figure 2, A-D
A 55-year-old man with chronic hepatitis C and multifocal nodular steatosis. Axial MRI images at two levels show multiple small, irregular areas of signal loss on the opposed-phase compared to the in-phase sequence, consistent with multifocal areas of focal fat deposition
Figure 2E
Figure 2E
A 55-year-old man with chronic hepatitis C and multifocal nodular steatosis. Fat-suppressed T2-weighted fast-spin-echo (FSE) sequence shows a homogeneous liver parenchyma without any focal lesions.
Figure 2F, G
Figure 2F, G
A 55-year-old man with chronic hepatitis C and multifocal nodular steatosis. Contrast-enhanced axial 3-D fat-suppressed fast-gradient-echo images do not show areas of arterial enhancement or washout on the portal venous phase to suggest HCC.
See this image and copyright information in PMC

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