Diagnostic Ultrasound - Abdomen and Pelvis

Hepatic Steatosis
Diagnoses: Liver
TERMINOLOGY
• Accumulation of increasing amount of triglycerides within
hepatocytes
IMAGING
• Diffuse fatty infiltration
○ Increased echogenicity with liver more echogenic than
kidney
○ Attenuation of US beam results in poor visualization of
diaphragm
○ Poor visualization of hepatic and portal veins
• Focal fatty infiltration
○ Hyperechoic nodule or multiple confluent hyperechoic
lesions
○ No mass effect with vessels running undisplaced through
lesion
○ Wedge-shaped/lobar/segmental distribution
• Focal fatty sparing
○ Direct drainage of hepatic blood into systemic circulation
KEY FACTS
○ Gallbladder bed: Drained by cystic vein
○ Segment 4 or anterior to portal bifurcation: Drained by
aberrant gastric vein
○ No mass effect with undisplaced vessel
TOP DIFFERENTIAL DIAGNOSES
• Steatohepatitis
• Fatty cirrhosis
• Hemangioma
• Metastasis or lymphoma
CLINICAL ISSUES
• Nonalcoholic steatohepatitis (NASH) may progress to
cirrhosis and hepatocellular carcinoma
DIAGNOSTIC CHECKLIST
• Rule out other liver pathologies that may mimic focal or
diffuse steatosis
(Left) Abdominal US shows
severe hepatic steatosis with a
diffusely echogenic liver, poor
visualization of the diaphragm
, and decreased visibility of
hepatic vein ſt and portal
vein walls. (Right) Oblique
US in a patient with severe
steatosis shows diffusely
increased liver parenchymal
echogenicity in comparison
with the right kidney ſt.
Lower frequency vector
transducer and harmonic
imaging was applied to
optimize penetration and
diaphragm is well visualized
st.
(Left) Transverse abdominal
US in a patient with moderate
hepatic steatosis shows
diffusely increased
parenchymal echogenicity ſt
with a poorly delineated right
hepatic vein wall st and a
hardly visible middle hepatic
vein . Part of the diaphragm
is not well visualized due to
poor acoustic penetration .
(Right) Color Doppler US in the
same patient depicts color
flow in the middle hepatic vein
st.
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