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Case of the Month – November

Dr Matthew Bastian-Jordan

History:

47 year old Japanese female received an external ultrasound for on and off pain in the right hypochondrium. The ultrasound demonstrated echogenicity in segment 4B adjacent to the porta thought to be a haemangioma. A follow up CT was ordered which also suggested a haemangioma.

The patient was then referred to a Gastroenterologist who ordered a Liver Shear Wave Elastography (SWE) and MRI for further assessment. The MRI confirmed the abnormality to reflect focal fatty deposition in a classic location adjacent to the porta hepatis.

Imaging and Findings:

Ultrasound:

Ultrasound assessment of the liver demonstrates the echogenic focus in segment 4B while Shear Wave Elastrography placed the patient in the low risk category (<F2). SWE of the abnormality demonstrated no increased stiffness to suggest malignancy. No other abnormality was seen (refer to images A and B).

MRI:

Chemical shift imaging assesses fat and water within a voxel and when both are present leads to signal loss on the out of phase study. In the MRI imaging along the porta hepatis, there is focal signal loss on the out of phase study confirming the ultrasound findings of focal fatty deposition (refer to images in and out of phase).

Management and Outcome:

The patient returned for follow-up 6 months later and had abstained from alcohol and undergone carbohydrate restriction in her diet. The follow up ultrasound demonstrated complete resolution of the focal fatty deposition, performed on the same ultrasound unit and by the same Sonographer.

 

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