Case 354:   Steatosis / Steatohepatitis

Diagnostic Category:

Clinical Presentation:

57 year old woman with cirrhosis and liver mass.

CT: Right lobe, pseudotumor

Imaging Findings:

Two phase CT shows hypodense well demarcated right lobar fatty transformation with mass like expansion of the right lobe, best seen on coronal reconstruction ("pseudotumor"). No significant enhancement between portal venous and equilibrium phase, typical for severe fatty infiltration. However right lobe was thought to be diffuse malignancy in an outside institution and was therefore biopsied. Biopsy showed steatohepatitis and no neoplasm or signs of viral hepatitis.  Note that this hypodense region is not creating any mass effect upon the hepatic vessels ("vessel penetration sign"). See similar case here.

Left lobe is shrunken and cirrhotic with gastric wall thickening, representing portal hypertension. Cirrhosis of the left lobe was not biopsied, but is likely result of non-alcoholic steatohepatitis.