Fatty Liver (aka steatosis)

Post mortem specimen of the liver with geographicregions of fatty change. (yellow appearance)
The liver was described as having a waxy texture
Ashley Davidoff MD
00393b

 

The prevalence of fatty liver

general population is about 15%,

alcohol consumption (>60 g per day)  45%

hyperlipidemia (50%)

obesity (body mass index, >30 kg/m2) (75%),

both obesity and high alcohol consumption (95%)

Post mortem specimen of the liver with geographic regions of fatty change. (yellow appearance)
The liver was described as having a waxy texture
Ashley Davidoff MD
00393b

Post mortem specimen of the liver with geographic regions of fatty change. in a patient with cirrhosis
Ashley Davidoff MD
00417
Intracellular/intracytoplasmic accumulation of fat droplets in liver cells
This is the histologic appearance of hepatic macrovesicular steatosis (fatty change). The lipid accumulates in the hepatocytes as vacuoles which appear as clear ‘bubbles” with H&E staining.
02189

Intracellular/intracytoplasmic accumulation of fat droplets in liver cells which are surrounded by fibrosis in a patient with a fatty liver and cirrhosis
Ashley Davidoff MD
02191

 

Ultrasound

53 year old male with a fatty liver. The ratio of liver echogenicity to kidney echogenicity is increased caused by an increase echogenicity making the kidney look dark. these findings are consistent with liver cirrhosis
Ashley Davidoff MD
130324

MRI

52 year old male with a fatty liver
LIVER FAT
T1 IN PHASE
The liver is bright on the in phase when compared to the out of phase study indicating diffuse steatosis
130319
52 year old male with a fatty liver
LIVER FAT
T1 Out of PHASE
The liver darkens on the out of phase indicating diffuse steatosis

52 year old male with a fatty liver
LIVER FAT
T1 IN PHASE

 

Diffuse Deposition

Normal (above) and Diffuse Fatty Infiltration (below)   Images a and b are from a normal patient. Note the density of the liver and compare to the density of the gallbladder in image b. The patient in c and d has diffuse steatosis and an enlarged liver. Note the difference in the liver density of the two cases and the difference in the relative densities of the gall bladders. The liver is normal in size in case A (a,b) and enlarged in case B (c.d) The patient in c and d is known to abuse both alcohol and drugs. The liver in images c and d is the same density as the gallbladder. This is called hepatisation of the gallbladder code liver gallbladder steatosis fatty liver normal large
Keywords:
liver gallbladder steatosis fatty liver normal large hepatisation of the gallbladder                                      Ashley Davidoff MD 37833c

 

 

Focal Deposition and Focal Sparing

 

CT scan shows segmental fatty change and fatty sparing in a patient with acute alcoholic hepatitis.
IVC thrombosis and gastric erosion 40277c code pancreas fx enlarged peripancreatic effusion exudate induration code liver fx segmental hypodensity dx fatty change steatosis code stomach fx thick walled code IVC thrombus code dx acute alcoholic pancreatitis complicated by IVC thrombosis gastric erosion imaging radiology CTscan inflammation
Keywords:
pancreas fx enlarged peripancreatic effusion exudate induration code liver fx segmental hypodensity dx fatty change steatosis code stomach fx thick walled code IVC thrombus code dx acute alcoholic pancreatitis complicated by IVC thrombosis gastric erosion imaging radiology CTscan inflammation

Axial CT shows segmental sparing of segment8 and 4 a and 2 with some sparing of the caudate in the region of the interlobar fissure. However segment 6/7 and 3 show steatosis with segmental pattern in 6/7 and heterogeneous pattern in 2/3
Ashley Davidoff MD
39659

Axial CT (top) and coronal reconstruction (bottom) show
peripheral fatty change ith central sparing .
Ashley Davidof MD
78207c

Patchy

Patchy fatty change in the left lobe by Ultrasound

 

Perivascular

fatty change around the hepatic veins. This pattern is known as perivascular fatty infiltration
key words
liver heterogeneous vein IVC fx deformed dx fatty liver dx steatosis imaging radiology CTscan ascites
Ashley DAvidoff MD
24155
38 year alcoholic man with abdominal pain liver failure and GI bleeding
CT without contrast at the level of the hepatic veins (a) shows a relatively dense IVC and some of the hepatic vein branches suggesting that the hepatic veins are surrounded by fat. The shape of the IVC (“saber IVC”) is also a sign of fatty liver.
In image b and c the veins are in enhancedin the portal and hepatic venous phase and image d is the 5 minute delay showing similar findings. These findings are compatable with the diagnosis of perivascular fatty infiltration around the hepatic veins

38 year alcoholic man with abdominal pain liver failure and GI bleeding
Coronal imaging showing hepatic veins and portal veins. Splenomegaly is present.

38 year alcoholic man with abdominal pain liver failure and GI bleeding
Ultrasound shows hypodense streaking of the liver hepatopetal blood flow in the portal vein and splenomegaly (16cms)

38 year alcoholic man with abdominal pain liver failure and GI bleeding
T1 IN PHASE _
T1 OUT of PHASE
T2 fat sat 005
Image a is the in phase study and image b the “out of phase confirming that the perivascular streaking is composed of fat
Ashley Davidoff MD
130305

 

38 year alcoholic man with abdominal pain liver failure and GI bleeding
Fiesta and
Fiesta fat
First image is a conventional T2 weighted image and the second with fat sat confirming that the perivascular changes are due to steatosis.
Ashley Davidoff MD
130307

 

38 year alcoholic man with abdominal pain liver failure and GI bleeding
G +
last image 5 min delay
Coronal post gad study shows that the fatty perivascular changes are specifically around the hepatic veins
Ashley Davidoff MD
130308

38 year alcoholic man with abdominal pain liver failure and GI bleeding
Ultrasound shows hypodense streaking of the liver hepatopetal blood flow in the portal vein and splenomegaly (16cms)

 

 

References

Radiographics

Okka, W et al

 

 

Metabolic Warehouse