Multifocal nodular steatosis mimicking malignancy

A previously fit man presented with breathlessness. Chest radiography showed right lower lobe density. Liver function tests, coagulation studies and alphafetoprotein levels were unremarkable. The patient’s breathlessness self-resolved, but chest–abdomen–pelvis CT performed to exclude malignancy revealed multiple hypodense liver lesions concerning for metastases (figure 1). Ultrasound-guided percutaneous liver biopsy targeting these lesions was successfully carried out. Histology showed fatty change but no evidence of malignancy. To avoid the possibility of sampling error, a second ultrasound-guided biopsy of the lesions was performed. Again, no malignant tissue was identified. MRI of the liver was performed (figure 2A,B). The out-of-phase images showed signal drop-out in the middle of the lesions (figure 2B), indicative of intracellular lipid content and suggestive of steatotic change. The patient was diagnosed with multifocal nodular steatosis (MNS), reassured and discharged. MNS lesions can be difficult to distinguish from metastatic disease because they...

Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Kang, J. H.-E., Wong, J. S.-Y., Williams, M. Tags: Images Source Type: research