Multifocal fatty liver nodules mimicking a metastatic disease: A case report

Abstract

Multifocal fatty liver nodules can present a diagnostic challenge due to their resemblance to metastatic liver disease. This case report illustrates the complexity of such scenarios through the presentation of a middle-aged male patient. Despite the common nature of fatty liver disease, characterized by hepatocyte fat accumulation leading to diffuse and uniform liver lesions, rare instances exhibit heterogeneous appearances. The case underlines the potential confusion arising from imaging modalities when multiple small nodules disperse throughout the liver, mimicking multifocal tumors or metastases. The report emphasizes the critical role of comprehensive diagnostic procedures in preventing misdiagnosis and unwarranted interventions. Effective management hinges on multidisciplinary collaboration among specialists, ensuring accurate differentiation and appropriate treatment. This study serves as a reminder of the intricacies involved in interpreting multifocal fatty liver nodules that may masquerade as metastatic disease, highlighting the need for precision in clinical practice.

Keywords: Fatty liver disease; Multifocal fatty liver nodules; Nonalcoholic fatty liver disease.

Fig. 1

Liver ultrasound reveals multiple centimetric nodules scattered throughout the liver parenchyma.

Fig. 2

Contrast-enhanced CT reveals multiple hypoattenuating lesions (A) without enhancement in the arterial phase (B), the portal phase (C), and the late phase (D) (arrow).

Fig. 3

MRI shows hypointense hepatic foci (arrow) with decreased signal intensity on the out-of-phase image (B) compared to the in-phase image (A), indicating intralesional fatty substance.

Fig. 4

The US-guided liver biopsy sample shows that the liver architecture is maintained. There is an accumulation of fats in the cytoplasm of the hepatocytes. No primary or metastatic lesions were found (Hematoxylin & Eosin stain, 200x).