focal fatty sparing adjacent to the gallbladder
The prevalence of FNH was 0.2% (n=81). Introduction. is fatty lever curable? 5). For continuous variables, the mean and standard deviation were calculated, while categorical attributes were presented in absolute and relative frequencies. Focal fat sparing and liver mass were the 2 most probable differential diagnoses suggested for the mentioned lesion. A chest X-ray on admission showed no abnormality. Close Figure Viewer Return to Figure Previous FigureNext Figure Doumas, M.; Imprialos, K.; Dimakopoulou, A.; Stavropoulos, K.; Binas, A.; Athyros, V.G. ; Guo, G.L. Katsiki, N.; Mikhailidis, D.; Mantzoros, C. Non-alcoholic fatty liver disease and dyslipidemia: An update. This condition, called focal sparing, can occur in diverse patterns. Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. Abdominal ultrasound, particularly of the liver, is a widely available, inexpensive technique that can be rapidly performed without exposing the patient to radiation. For more information, please refer to ; McKillop, J.H. Following parameters were recorded and evaluated on the basis of the above-mentioned research question: positive/negative finding, nature of tumor, age and gender of the patient, number of foci (solitary, multiple), the respective ultrasound characteristics of the focus and size of the tumor (maximum diameter). Lawrence, D.A. You seem to have javascript disabled. Eur J Radiol 83:930934, Marin D, Galluzzo A, Plessier A, et al. 4 and 5). Advertisement intended for healthcare professionals, For reprints and all correspondence: Motohisa Kato, Second Department of Surgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500, Japan. At surgery, the tumor was found to be exposed on the surface of the anterior segment, adjoining not the middle hepatic vein but the right hepatic vein. 1. (2001) Incidence and significance of small focal liver lesions in MRI. The prevalence of FNH lies between 0.8% and 3.2% [1215], of hepatic adenoma from 0.4% to 1.5% [11, 12, 15, 16], and of focal fatty sparing between 7.2% and 19.8% [8, 17, 18]. ; Finn, J.P.; Stark, D.D. Google Scholar, Sanfelippo P, Beahrs O, Weiland L (1974) Cystic disease of the liver. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). Detection of a mass within a fatty liver can be difficult by CT. Irregular fatty infiltration can show a roundish or well circumscribed appearance, and may be solitary or multiple, simulating hepatic masses (25). https://doi.org/10.3390/curroncol28040265, Lee, Michelle C. M., Jacob J. Kachura, Paraskevi A. Vlachou, Raissa Dzulynsky, Amy Di Tomaso, Haider Samawi, Nancy Baxter, and Christine Brezden-Masley. The number of focal lesions was considered separately up to a figure of five lesions. Google Scholar, Chiche L, Adam JP (2013) Diagnosis and management of benign liver tumors. ; Packard, C.J. Del pilar fernandez M, Bernardino ME. This distribution is the same as that seen in focal fatty sparing and is thought to relate to variations in vascular supply. The peak age for FNH occurred in the youngest patient group with 34.6% (n=28) of the diagnosed lesions and fell continuously with increasing age. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. As was already put forward as a possible explanation in the case of FNH, this could be due to the age of the study participants, the size of the patient population investigated, and the improved differentiation possibilities of modern ultrasound equipment. In order to be human-readable, please install an RSS reader. Miwa, M.; Ura, M.; Nishida, M.; Sawada, N.; Ishikawa, T.; Mori, K.; Shimma, N.; Umeda, I.; Ishitsuka, H. Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. methicillin-resistant Staphylococcus aureus, Oxford University Press is a department of the University of Oxford. ; Hurley, D.L. Despite its frequent association with liver injury, oxaliplatin is classically known to damage the liver via sinusoidal dilation and is thought to have a limited role in inducing steatohepatitis [, Since the FDA approval of capecitabine in 2001 as a chemotherapeutic agent, the oral route of 5-FU delivery became a mainstay of colorectal cancer treatment, alongside intravenous infusion. Canadian Cancer Societys Advisory Committee on Cancer Statistics. Haas, J.T. Abbreviations: BMI, Body Mass Index; FOLFOX, oxaliplatin, fluorouracil, and folinic acid; XELODA, capecitabine; FUFA, fluorouracil and folinic acid. Lupsor M, Badea R. Imaging diagnosis and quantification of hepatic steatosis: is it an accepted alternative to needle biopsy? Since drug-induced hepatotoxicity was described by Grieco et al. Ultrasound features only become apparent when the amount of fat reaches 15-20%. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-1344, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1344,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/focal-hepatic-steatosis/questions/1098?lang=gb"}. Naturally, these cannot be recorded in retrospective ultrasound prevalence studies. Mostbeck GH (1996) Ultrasound screening examination of the abdomen: of value or senseless? 4) clearly showed a wedge-shaped hypointese area in the anterior segment, suggesting ischemia in this area. The relative risk of developing steatosis was not significantly different regardless of statin therapy status at the time of adjuvant chemotherapy (RR 0.45, 95% CI 0.10 to 2.75) after adjusting for sex, BMI, type 2 diabetes mellitus, and hyperlipidemia (, In the present study, the adjusted relative risk of adjuvant chemotherapy reflected a moderately increased risk of steatosis, although the confidence intervals were wide. Schumacher, J.D. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. These segments were rarely spared in patients with previous cholecystectomy. Areas of focal fatty sparing of the liver adjacent to the gallbladder and porta hepatis, absolute value of liver density less than 40 HU or a density difference greater than 25 HU between the spleen and liver on contrast-enhanced CT, increased echogenicity of the liver, attenuation of the ultrasound wave, loss of definition of the diaphragm, and poor delineation of the intrahepatic architecture on ultrasound and signal drop of liver parenchyma on the T1 weighted out of phase imaging on MRI was considered fatty liver [, A log binomial regression model was used to calculate adjusted relative risks. future research directions and describes possible research applications. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The heart and lungs were clear to auscultation and palpation of the liver revealed no abnormality. In our study, this figure fell almost linearly with increasing age and amounted to only 66.8% in the group of patients over 70years of age. Retrospective and prospective studies based on ultrasound have reported prevalence data for hepatic cysts of between 0.1% and 11.3% [7, 9, 23, 29]. The highest prevalence was found in younger women, and 86.4% (n=70) of all patients with FNH were females. 1991;181 (3): 809-12. Note: data are presented as frequency (percent), unless otherwise specified. Gastroenterol Res Pract 2015:749235, Khosa F, Warraich H, Khan A, et al. Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. In terms of the abnormal finding in the anterior segment, non-enhanced CT suggested focal sparing and sonography suggested a metastatic tumor. Idilman IS, Ozdeniz I, Karcaaltincaba M. Hepatic Steatosis: Etiology, Patterns, and Quantification. (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. Women were somewhat more affected (56.1%, n=1477) than men (43.9%, n=1154). The authors declare no conflict of interest. Two further examinations were therefore performed to distinguish between these two types of lesion. Scand J Gastroenterol 50:355359, Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C (2013) Fortuitously discovered liver lesions. The used probes are C2-5, C1-5, and C1-6 (16MHz). Motohisa Kato, Shigetoyo Saji, Masayuki Kanematsu, Daizo Fukada, Kiichi Miya, Takao Umemoto, Katsuyuki Kunieda, Yasuyuki Sugiyama, Ikuhide Kuwahara, Kuniyasu Shimokawa, A Case of Liver Metastasis from Colon Cancer Masquerading as Focal Sparing in a Fatty Liver, Japanese Journal of Clinical Oncology, Volume 27, Issue 3, June 1997, Pages 189192, https://doi.org/10.1093/jjco/27.3.189. Although these four sequences suggested focal sparing, dynamic MR images clearly showed irregular enhancement in the abnormal area of the anterior segment, suggesting a metastatic tumor (image not shown). The prevalence figures reported in previous ultrasound studies for FNH were 0.8%3.2% and for hepatic adenoma 0.4%1.5% [8, 15, 17, 20]. With only 19 cases and hence a prevalence of 0.04%, hepatic adenoma was the rarest of the liver lesions we investigated. Curr Gastroenterol Rep 17:12, Barthelmes L, Tait IS (2005) Liver cell adenoma and liver cell adenomatosis. Become a Gold Supporter and see no third-party ads. Dr. Yvette Kratzberganswered Pediatrics 26 years experience Talk now https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. The sample size of 37 in the statin group meant that the power of the statistical analysis was smaller than the widely accepted threshold of 80%. PubMed Central It is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. It is therefore difficult to compare the various study results and apply them to routine ultrasound primary diagnostics. Of the remaining 193 cases, patients receiving adjuvant chemotherapy (, Hepatic steatosis is characterized by the infiltration and accumulation of triglyceride within the liver parenchyma [, There is currently no approved pharmacologic treatment for hepatic steatosis, whether metabolic syndrome- or drug-induced. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas ().This condition, called focal sparing, can occur in . The data are not publicly available due to patient privacy. Abbreviations: BMI (Body Mass Index). Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. Non-enhanced CT on admission in 1996, showing a wedge-shaped hyperdense area in the anterior segment of the right lobe. At further existing unclarity, an MRI was performed in unclear findings at MRI puncture of the lesions were attempted. Urinary Tract and male reproductive system Is hepatic steatosis reversible? All lesions were examined also by color and power Doppler ultrasound. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive At least one of the lesions of interest was found in a total of 6851 patients (15.1% of the population examined). ; Saeian, K.; Lalehzari, M.; Aronsohn, A.; Gorospe, E.C. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. ; Lawson, T.L. Unusual patterns of hepatic steatosis caused by the local effect of insulin revealed on chemical shift MR imaging. The diagnosis of FNH was confirmed primarily by CEUS. St. Michaels Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada, Medical Sciences Building, 1 Kings College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada, Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada, Lunenfeld-Tanenbaum Research Institute, 600 University Ave, Toronto, ON M5G 1X5, Canada. A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). Sonography shows an elliptical mass surrounded by a halo, indicated by the white wedges, in the anterior segment of the right lobe; its internal echogenicity is irregular. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. Overall, more adenomas were diagnosed in the younger patient groups under 50years of age than in the older ones. (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. PubMed Central It was most often found in the 5160years age group; the mean age of the patients with focal fatty sparing was 54.914.5years. ; Congdon, L.; Edwards, K.L. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. PubMedGoogle Scholar. no financial relationships to ineligible companies to disclose. An evidence-based review of statin use in patients with nonalcoholic fatty liver disease. ; MacFarlane, P.W. Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. (2016) Seminars in ultrasound, CT, and MR. 37 (6): 501-510. ; Perlman, S.J. It was most often found in the 51-60 years age group; the mean age of the patients with focal fatty sparing was 54.9 14.5 years. In conclusion, the present case was difficult to diagnose because the tumor was hidden within the area of focal sparing, and dynamic contrast enhancement techniques, including CTA, CTAP and dynamic MRI, were useful for diagnosis. Differential diagnosis Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-33796. 4).MRI is very useful for making the diagnosis of focal hepatic steatosis, which appears isointense or hyperintense to liver on in-phase images and loses signal on out-of-phase images. Woods, C.P. Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. Unable to process the form. At the time the article was last revised Jeremy Jones had no recorded disclosures. Gut Liver. With our determined prevalence of 5.8%, we are also here in the mid-range. The statistical calculations were carried out using the statistics software SAS 9.2 (SAS Institute Inc., Cary, North Carolina, USA) and the data evaluated using descriptive statistics. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. Nodular focal fatty sparing of liver sometimes is a mimicker of malignant lesion, especially metastatic tumor. Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. ; Laurie, J.A. Canadian Liver Foundation 2017 [cited 2020 May 24]. Serum electrolytes, blood urea nitrogen, creatinine, glucose, total bilirubin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), leucine aminopeptidase (LAP) and gamma-glutamyltranspeptidase (g-GTP) were all within the normal ranges. For example, the prevalence of hepatic hemangioma determined in the studies ranged from 0.1% to 20.0% and that of hepatic cysts from 0.06% to 17.8%. 2. All the cases of focal fatty sparing that we encountered were solitary findings in its typical location in liver segment IV in the region of the gallbladder bed. J Clin Pathol 39:183188, Article Reversible hepatic steatosis in patients treated with interferon alfa-2A and 5-fluorouracil. In most cases, gallstones blocking the tube leading out of the gallbladder cause cholecystitis. J Ultrasound Med 14:649652, Feldman M (1958) Hemangioma of the liver. Color and power Doppler sonography were performed in 80 patients with a fatty liver that appeared as a fine echogenic pattern with considerable deep attenuation on sonography. Vigano, L.; De Rosa, G.; Toso, C.; Andres, A.; Ferrero, A.; Roth, A.; Sperti, E.; Majno, P.; Rubbia-Brandt, L. Reversibility of chemotherapy-related liver injury. The size and age structure of the respective study populations, as well as the quality of the ultrasound equipment used, need to be considered here. Focal sparing shows oppsite patterns on US and CT: decreased echogenicity on US images and high attenuation on CT images. Google Scholar, Linhart P, Bnhof JA, Baqu PE, Pering C (1998) Ultrasound in diagnosis of benign and malignant liver tumors. Prevention of coronary heart diseases with pravastatin in men with hypercholesterolemia: West of Scotland coronary prevention study group. Other imaging techniques also demonstrated a wedge-shaped area which was difficult to distinguish from mere focal sparing in the fatty liver. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. Available online: Goldberg, D.; Ditah, I.C. CT-supported studies have reported the highest figures for prevalence [15, 19]. Please let us know what you think of our products and services. Mechanistic review of drug-induced steatohepatitis. World J Gastroenterol 19:31733188, Article analyzed and interpreted the data. 3) showed a wedge-shaped hypointense area, as seen on non-enhanced CT, and T2-weighted images (Fig. It was suggested that this fibrotic liver tissue corresponded to the area of focal sparing seen on CT and MR images. Opposed-phase images showed a hyperintense area in the entirely hypointense liver (Fig. Baseline and . Besides the clinical parameters and the patients medical history, the quality of the ultrasound equipment used and the investigators experience also play a significant role. Kratzer et al. Introduction. Sohn J, Siegelman E, Osiason A. Moertel, C.; Fleming, T.; Macdonald, J.; Haller, D.G. PubMed In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean SD, 35.9 1.14 months). Although standard MR sequences are less helpful for visualization and characterization of fatty infiltration, chemical shift images (opposed- and in-phase images) are quite useful for depicting fat distribution and assist the diagnosis of focal fatty infiltration or sparing (7). J Med Assoc Thai 91:10721075, PubMed ; Francque, S.; Staels, B. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. 4: 3030-3040. Thus, in this study, we sought to describe the frequency of CAS in stage IIIII CRC patients and to determine the incidence of CAS in patients who were prevalent users of statins during their adjuvant chemotherapy. Kreft, B.P. The level of significance was set at =5%, and the p value was given to four decimal places. Conclusions The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion. The research group of Koseoglu reported a prevalence of focal fatty sparing of up to 19.8 [18] Strunk et al. Focal fat deposition and focal fatty sparing. Chemotherapy-associated steatosis is pathologically indistinguishable from NAFLD, which has a benign onset as simple hepatic steatosis, but can asymptomatically progress to steatohepatitis [, Despite these risks, current treatment for hepatic steatosis is limited to changes in lifestyle to mitigate cardiovascular risk factors [, In this study, the primary mode of determining steatosis status in patients included a review of the medical records and the abdominal images (CT, ultrasound and MRI) by a single radiologist. The histological findings eventually revealed that the tumor, an adenocarcinoma, was surrounded by fibrotic tissue that mimicked focal sparing. The prevalence of hepatic hemangioma was 3.3% (n=1640), while that of FNH was 0.2% (n=81) and that of hepatic adenoma was 0.04% (n=19). Improved overall survival with oxaliplatin, fluorouracil, and leucovorin and adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. The second most commonly diagnosed liver lesion was the hepatic cyst, with 5.8% (n=2631). The ultrasound results in a population of (n=45,319) hospital patients over a period of 10years were examined retrospectively and evaluated for the diagnosis of benign focal liver lesions [hepatic cysts, hepatic hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing]. Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. The number of recent ultrasound studies on the prevalence of benign liver lesions is relatively limited. Studies concerning the prevalence of benign focal liver lesions present a quite heterogeneous picture as regards the precise research question posed, the size of the population studied, and the investigative methods used. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. This study sought to examine hepatic steatosis, an increasingly recognized health concern worldwide. CT arteriography and dynamic magnetic resonance images were useful for diagnosing this metastatic tumor. interesting to readers, or important in the respective research area. The largest measured cyst diameter averaged 22.3mm. Piscaglia, F.; Svegliati-Baroni, G.; Barchetti, A.; Pecorelli, A.; Marinelli, S.; Tiribelli, C.; Bellentani, S. HCC-NADFL Italian Study Group. Radiology. (d) In-phase MR images show a hypointense area in the entirely hyperintense liver (TR = 120, TE = 4.2). It is mostly idiopathic but it has been often related to obesity, diabetes mellitus, alcohol use, hepatitis, starvation, steroid therapy or parenteral nutrition [].The degree of the fatty infiltration can be focal, diffuse or patchy []. Capecitabine: An overview of the side effects and their management. This distribution is the same as that seen in focal fatty sparing and is thought to relate to variations in vascular supply. All articles published by MDPI are made immediately available worldwide under an open access license. The study was conducted in accordance with the Guidelines of the Declaration of Helsinki and the recommendations of Good Clinical Practice. 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. A total of 44.9% of these patients were outpatients and 55.1% inpatients. Conclusion: Detection of focal fatty sparing is associated with an increased attenuation coefficient and is thus an expression of higher-grade hepatic fatty degeneration. The purpose of this study was to investigate whether fatty sparing adjacent to the gallbladder fossa is related to efferent blood flow from the gallbladder wall. There are some case reports about this kind of tricks revealed by computed tomography (CT) and magnetic resonance imaging. Abdom Radiol 41, 2532 (2016). Recognition of this finding is important to prevent the erroneous belief that the region of sparing is itself a mass. In this study, Stage IIIII colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. On admission, his general condition was good. ; Cohen, J.C.; Grundy, S.M. However, the occurrence of a hepatic adenoma is associated with the ingestion of oral contraceptives, which may be reflected in our results, since we found the majority of adenomas in women aged below 50years [34]. Sigler, M.A. When located in characteristic locations then there is usually little difficulty in making the correct diagnosis. CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. Eur J Radiol 61:3343, Vaidyanathan S, Horrow MM (2007) Case 6: diagnosis: focal fatty sparing of the caudate lobe mimicking a mass. Common patterns include diffuse fat accumulation, diffuse fat accumulation with focal sparing, and focal fat accumulation in an otherwise normal liver. J Am Soc Echocardiogr 25:553557, Kratzer W, Akinli AS, Bommer M, et al. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. ; Compton, C.C. AJR Am J Roentgenol. the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, Eur J Clin Microbiol Infect Dis 29:307309, Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G (2014) Lets go out of the breast: prevalence of extra-mammary findings and their characterization on breast MRI. Kammen B, Pacharn P, Thoeni R et al. Focal Fatty Infiltration of the Liver. Google Scholar, Collin P, Rinta-Kiikka I, Rty S, Laukkarinen J, Sand J (2015) Diagnostic workup of liver lesions: too long time with too many examinations. We often found a high attenuation region around the gallbladder bed in the fatty liver patients on CT examination. permission is required to reuse all or part of the article published by MDPI, including figures and tables. ; Gupta, R.K. Focal fatty infiltration increases the echogenicity of the liver on US images and produces low attenuation on CT images. Wolfgang Dhnert. ; Gasbarrini, A.; Gasbarrini, G. Fatty liver and drugs. Habib, M.B. No specific therapy is available except to eliminate the cause or treat the underlying disorder. Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. CT during arterial portography (CTAP) (Fig. The finding of a FNH or an adenoma is rarely a random discovery. Rofo 156:325327, Koseoglu K, Ozsunar Y, Taskin F, Karaman C (2005) Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings. Ann Surg 179:922925, Seitz K, Strobel D, Bernatik T, et al. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Editors Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Postoperative liver insufficiency and sepsis were diagnosed and intensive care including plasma exchange and administration of vancomycin was performed. Focal hepatic steatosis. 3). ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. Our figure of 0.18% is markedly lower than the data published to date. Inclusion criterion for this analysis was a positive sonographic diagnosis of benign focal liver lesions (hepatic cysts, hepatic hemangioma, FNH, hepatic adenoma and focal fatty sparing; Figs. You are accessing a machine-readable page. We present the radiological features of this case and discuss how to arrive at a correct diagnosis.