A 53-year-old patient with chronic hepatitis C virus infection was referred because of the presence of multiples ultrasonographic images simulating liver metastasis. Physical examination was normal. Liver function test showed increased levels of aminotransferases, high levels of g-glutamyltransferase and normal alkaline phosphatase. Liver ultrasound identified multiples nodules that measured 0.5-2 cm in diameter, located in both lobules. Serum alpha-fetoprotein level was 13 ng/mL. A fine-needle aspiration cytology failed to reveal neoplastic cells.
Liver biopsy showed chronic hepatitis, grading 7/18, staging 1/6 in Ishak score; moderate steatosis with multiples microlipogranulomas.
This case illustrates an infrequent ultrasonographic presentation as well as a rare clinical entity, since fatty change of the liver is generally found as a diffuse process involving the entire organ. On the other hand, the lesions are generally encountered incidentally at post mortem autopsy.1
Focal spared areas of fatty liver may be interpreted as pseudotumors because of the relatively high intensity of fatty areas of the liver, sometimes simulating metastasis.2
Knowledge and awareness of these non-neoplastic nodular lesions may have importance in the differential diagnosis of space-occupying lesions of the liver.
