RUQ US; 50-year old diabetic female, vague abdominal discomfort

Liver measured 17 cm in mid-clavicular line Important findings? Dx? Confirmatory studies?
 
Answers
Fatty Infiltration with Focal Sparing
 

• Fatty Infiltration with poorly controlled DM (50%), pregnancy, steroids, chemo, obesity, TPN, trauma, Reye’s syndrome, etc.
• Spared portion is normally the medial segment of the left lobe
• Normal vessels in both fatty & spared liver suggestive
• Increased attnuation of sound beam characteristic of fat, not fibrosis

Fatty Infiltration – CT Correlation

• Marked hypoattenuation of liver, w/ normal vessels (liver is darker than portal vessels / IVC); reversal of liver-spleen density relationship