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
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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
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Post mortem specimen of the liver with geographic regions of fatty change. in a patient with cirrhosis Ashley Davidoff MD 00417
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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
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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
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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
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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
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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
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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
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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
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Axial CT (top) and coronal reconstruction (bottom) show peripheral fatty change ith central sparing . Ashley Davidof MD 78207c
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Patchy
Patchy fatty change in the left lobe by Ultrasound
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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
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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.
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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)
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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
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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
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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
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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)
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Liver steatosis without contrast Ashley DAvidoff MD TheCommonVein.netLiver steatosis with contrast Ashley DAvidoff MD TheCommonVein.netLiver steatosis on US showing relative increase echogenicity of the liver in relation to the kidney as well lack of visualisation of Glissons capsule extensions along the vessels Ashley Davidoff MD TheCommonVein.net
