Fatty infiltration of the liver: analysis of prevalence, radiological and clinical features and influence on patient management (original) (raw)
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Imaging Features of Perivascular Fatty Infiltration of the Liver: Initial Observations
Radiology, 2005
PURPOSE: To retrospectively identify and describe the imaging features that represent perivascular fatty infiltration of the liver. MATERIALS AND METHODS: The institutional review board approved the study and waived informed consent. The study complied with the Health Insurance Portability and Accountability Act. Ten patients (seven women, three men; mean age, 78 years; range, 31-78 years) with fatty infiltration surrounding hepatic veins and/or portal tracts were retrospectively identified by searching the abdominal imaging teaching file of an academic hospital. The patients' medical records were reviewed by one author. Computed tomographic (CT), magnetic resonance (MR), and ultrasonographic (US) imaging studies were reviewed by three radiologists in consensus. Fatty infiltration of the liver on CT images was defined as absolute attenuation less than 40 HU without mass effect and, if unenhanced images were available, as relative attenuation at least 10 HU less than that of the spleen; on gradient-echo MR images, it was defined as signal loss on opposed-phase images compared with in-phase images; and on US images, it was defined as hyperechogenicity of liver relative to kidney, ultrasound beam attenuation, and poor visualization of intrahepatic structures. Perivascular fatty infiltration of the liver was defined as a clear predisposition to fat accumulation around hepatic veins and/or portal tracts. For multiphase CT images, the contrast-to-noise ratio was calculated for comparison of spared liver with fatty liver in each imaging phase. RESULTS: Fatty infiltration surrounded hepatic veins in three, portal tracts in five, and both hepatic veins and portal tracts in two patients. Six of the 10 patients had alcoholic cirrhosis, two reported regular alcohol consumption (one of whom had acquired immunodeficiency syndrome and hepatitis B), one was positive for human immunodeficiency virus, and one had no risk factors for fatty infiltration of the liver. In three of the 10 patients, fatty infiltration was misdiagnosed as vascular or neoplastic disease on initial CT images but was correctly diagnosed on MR images. CONCLUSION: Perivascular fatty infiltration of the liver has imaging features that allow its recognition.
Radiologic evaluation of nonalcoholic fatty liver Disease
Medical Journal of Viral Hepatitis
Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. NAFLD comprises a range of liver conditions varying in severity of hepatocytes injury and resulting fibrosis-cirrhosis risk. Among these, hepatic steatosis (fatty liver) is referred to as NAFL, and nonalcoholic fatty liver (NAFL) is defined as a more grave process with both fat and inflammation in the liver that over time can cause liver cirrhosis (steatohepatitis). Liver biopsy is the gold standard method to differentiate, whether the patient with fatty liver has only steatosis, or NASH. Unfortunately, liver biopsy has well-known limitations (invasiveness and sampling variability) and cannot be proposed for all patients, especially given the high prevalence of NAFLD worldwide. This review discuss the radiologic evaluation of liver steatosis and fibrosis for patients with NAFLD.
The Clinical, Biochemical, Serological and Radiological Profile of Fatty Liver Disease
Back ground: Fatty liver disease has a rapidly increasing incidence worldwide due to multiple genetic and socioeconomic factors, affecting people from all age groups.Initially thought to be a disease of only the obese ,fatty liver is now known to be prevalent in lean individuals too.It is a disorder which goes undiagnosed for a very long time and its presence increases the risk of chronic liver disease. Methods: A total number of 96 patients diagnosed as fatty liver on ultrasound, irrespective of the presenting complaint were enrolled for the study.A detailed analysis of the clinical , biochemical , serological and radiological profile including liver elastography was done for all the patients and the data was analysed with the help of SPSS. Results: Fatty liver was found to be more common in males as compared to females. Non-alcoholic fatty liver disease [NAFLD] was found to be the most common cause of fatty liver followed by alcoholic fatty liver disease , Hepatitis B and Hepatitis C. Diabetes Mellitus and Metabolic syndrome were present in almost half of the total fatty liver cases. Liver enzymes were deranged in majority of the patients. Raised triglycerides were seen in majority of the patients. The agreement between ultrasound and elastography for grading of fatty liver was low at 55%. Conclusion: All patients diagnosed to have fatty liver must be investigated extensively for the underlying etiology. As fatty liver represents the reversible stage in the pathogenesis of chronic liver disease , timely intervention can successfully prevent progression of disease into liver cirrhosis.Liver Elastography is prefereable to ultrasonography for grading of fatty liver.
Journal of Gastroenterology and Hepatology, 2005
To the Editor, We herein report a very rare case of a ruptured massforming type peripheral cholangiocarcinoma (PCC) that uniquely showed a papillary pattern of tumor growth with little fibrous stroma. It is possible that the tumor originated from an intraductal growth type tumor and eventually formed an intrahepatic mass. PCC is the second most common primary tumor of the liver following hepatocellular carcinoma (HCC). Grossly, PCC is divided into three types: mass-forming, periductal infiltrating and intraductal growth. 1 Although spontaneous rupture of HCC is not infrequently encountered, PCC generally forms a hard tumor with abundant fibrous stroma, thus these tumors seldom rupture spontaneously. We describe a very rare case of a ruptured mass-forming type PCC. A 52-year-old man presented with sudden and severe epigastric pain after complaining of dull epigastric pain that lasted 1 week. At the time of arrival, the patient was in cardiovascular shock. He received rapid fluid resuscitation and was hemodynamically stabilized. Laboratory data showed elevations of the white blood cell count (13,000/mm 3), alkaline-phosphatase (760 IU/L) and gamma-glutamyl transferase (213 IU/L). Tumor markers, including alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9, were normal. Serological tests for hepatitis B and C were negative. Contrast-enhanced computed tomography (CT) demonstrated a 10 cm tumor with mild peripheral enhancement in the left and caudate lobes of the liver with a surrounding hematoma (Fig. 1a). Extensive irregular non-enhanced parts (that suggested tumor necrosis) were noted within the tumor. Hepatic angiogram disclosed a large hypervascular tumor. Although extravasation of the contrast material was not noted, emergency selective transcatheter arterial embolization (TAE) was performed under the diagnosis of a ruptured hepatic tumor. Stainless steel
Non-alcoholic fatty liver disease - clinical and histopathological aspects
2016
INTRODUCTION We conducted a retrospective study on patients who were hospitalized in the Emergency County Hospital of Craiova, Romania, between 2009-2014. We selected 75 patients out of 248 cases of fatty liver disease who underwent liver biopsies performed during surgical procedures for various diagnoses. PATIENTS AND METHODS We analyzed the patients' data recorded in examination charts: anthropometric parameters [height, weight, body mass index (BMI), abdominal circumference], metabolic lab tests (blood glucose, lipid profile), liver destruction enzymes, imaging examinations (abdominal ultrasound). The pathological study was performed on specimens directly after sampling as well as after staining. RESULTS After analyzing the results of the histological examination, we grouped our studied patients according to the degree of the liver steatosis: 21 (28%) cases with mild steatosis, 46 (61.33%) cases with moderate disease and eight (10.66%) cases with severe steatosis. The necroti...
ACG Case Reports Journal, 2021
ocal nodular fatty infiltration of the liver is a pseudotumor visualized as a highly echoic lesion on sonography. On computed tomography (CT), focal nodular fatty infiltration is generally characterized by a low-density area with no mass effect. 1 Although focal nodular fatty infiltration must be differentiated from primary liver cancer, a metastatic liver tumor, or hepatic hemangioma, this can be difficult with CT or sonography alone. When differential diagnosis is difficult from imaging investigations alone, biopsy proof of the tumor is necessary before therapy is commenced. The appearance of numerous small multifocal nodular fatty infiltrations in both hepatic lobes may mimic that of metastatic liver disease, leading to incorrect therapy. Particularly if the patient has had malignant disease in the past, multifocal nodular fatty infiltrations may be misdiagnosed, and incorrect therapy may be performed without adequate examination or differential diagnosis of the primary lesion. Although magnetic resonance imaging (MRI) and fine-needle biopsy are reportedly useful in diagnosing focal fatty infiltration of the liver, 2-4 the value of enhanced sonography has not been reported in this situation. We encountered a case of multifocal nodular fatty infiltration in which findings of the late parenchymal phase of enhanced sonography with Levovist (SH U 508A; Schering AG, Berlin, Germany) were useful in ruling out malignancy.