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Lobar distribution pattern of the focal fatty infiltration

Case contributed by Amr Farouk
Diagnosis certain

Presentation

History of cholecystectomy presenting with recurrent abdominal pain.

Patient Data

Age: 45 years
Gender: Female

CT showed multiple bi-lobar hepatic branching areas of low CT density on all phases attaining a dominant peri-portal distribution with less fatty parenchymal bridges (pseudo-septations). They are exerting no mass effect on the surrounding structures with vessels passing via these areas (vessel penetration sign). CT density of the aforementioned areas had a mean attenuation value - 30 HU (fat density)

The aforementioned bilobar hepatic parenchymal areas showed hyperintense signal on T1 with signal drop out on the out-of-phase sequence confirming its fatty nature.

Case Discussion

Bilobar hepatic parenchymal lobar areas of low CT density reading a fat density. MRI showed high T1 signal with a drop in signal on out-of-phase images.

The CT and MR picture pathognomonic of focal fatty infiltration.

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