Case Study: Hypoechoic Liver Lobe

Can you solve the case? Use your POCUS expertise to make the diagnosis in the case study below.

A 62-year-old male patient’s lab results showed elevated liver enzymes. There is no history of fever or abdominal pain. An ultrasound examination of the left lobe of the liver showed the view below. The caudate lobe of the liver was hypoechoic. The yellow arrow is pointing to the caudate lobe of the liver.

 

What is the most probable diagnosis?

A. Liver abscess
B. Liver metastasis
C. Fatty liver with focal sparing of the caudate lobe

 

A static ultrasound image of a hypoechoic caudate lobe of a liver. A yellow arrow points to the caudate lobe of the liver.

Image courtesy of UltrasoundCases.info owned by SonoSkills.

 

The most probable diagnosis is fatty liver with focal sparing of the caudate lobe.

Explanation

Focal areas of sparing will appear relatively hypoechoic on ultrasound as compared to the adjacent area of fatty infiltration of the liver which will appear hyperechoic. Be sure to not miss liver metastases or hepatocellular carcinoma. Always correlate clinically.

 

References

  1. https://radiopaedia.org/articles/focal-fatty-sparing-of-the-liver?lang=us