📄 SCRS
Hepatic steatosis
(Fatty Liver)
Hepatic steatosis ultrasound case study
USG
Septated pleural effusion ultrasound case study
CASE–1
Clinical History
A 45-year-old patient was referred for abdominal ultrasound due to abnormal liver function tests, obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, or incidental fatty liver detected on previous imaging. The patient may be asymptomatic or complain of mild right upper quadrant discomfort or fatigue.
Ultrasound Findings
Ultrasound examination demonstrates a mildly enlarged liver measuring approximately 155 mm at the midclavicular line (MCL). The liver shows diffusely increased echogenicity compared with the right renal cortex, consistent with diffuse fatty infiltration (Grade I hepatic steatosis). Mild posterior beam attenuation is present with preserved visualization of the intrahepatic vessels and diaphragm. The hepatic echotexture is otherwise homogeneous with smooth liver margins. No focal hepatic lesion or intrahepatic biliary dilatation is identified. The portal vein demonstrates normal hepatopetal flow on Color Doppler examination.
Report Line
The liver is mildly enlarged, measuring approximately 155 mm at the midclavicular line (MCL). Diffuse mild increase in hepatic echogenicity is noted compared with the right renal cortex, consistent with Grade I hepatic steatosis (fatty liver). Mild posterior beam attenuation is present with preserved visualization of the intrahepatic vessels and diaphragm. No focal hepatic lesion or intrahepatic biliary dilatation is identified. Portal venous flow is normal on Color Doppler imaging.
Impression
Mild hepatomegaly with Diffuse mild hepatic steatosis (Fatty Liver Grade I).
CASE–2
Clinical History
A 45-year-old patient was referred for abdominal ultrasound due to abnormal liver function tests, obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, or incidental fatty liver detected on previous imaging. The patient may be asymptomatic or complain of mild right upper quadrant discomfort or fatigue.
Ultrasound Findings
Ultrasound examination demonstrates a mildly enlarged liver measuring approximately 155 mm at the midclavicular line (MCL). The liver shows diffusely increased echogenicity compared with the right renal cortex, consistent with Grade II hepatic steatosis. Moderate posterior beam attenuation is present with mildly reduced visualization of the intrahepatic vessels and diaphragm. The hepatic echotexture is homogeneous with smooth liver margins. No focal hepatic lesion or intrahepatic biliary dilatation is identified. The portal vein demonstrates normal hepatopetal flow on Color Doppler examination.
Report Line
The liver is mildly enlarged, measuring approximately 155 mm at the midclavicular line (MCL). Diffuse moderate increase in hepatic echogenicity is noted compared with the right renal cortex, consistent with Grade II hepatic steatosis (fatty liver). Moderate posterior beam attenuation is present with mildly reduced visualization of the intrahepatic vessels and diaphragm. No focal hepatic lesion or intrahepatic biliary dilatation is identified. Portal venous flow is normal on Color Doppler imaging.
Impression
Mild hepatomegaly with diffuse moderate hepatic steatosis (Fatty Liver Grade II).
CASE–3
Clinical History
A 45-year-old patient was referred for abdominal ultrasound due to abnormal liver function tests, obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, or incidental fatty liver detected on previous imaging. The patient may be asymptomatic or complain of mild right upper quadrant discomfort, fatigue, or features suggestive of advanced hepatic steatosis.
Ultrasound Findings
Ultrasound examination demonstrates a mildly enlarged liver measuring approximately 155 mm at the midclavicular line (MCL). The liver shows marked diffuse increase in echogenicity compared with the right renal cortex, consistent with Grade III hepatic steatosis. Marked posterior beam attenuation is present with poor visualization of the intrahepatic portal venous walls, hepatic veins, and diaphragm due to severe fatty infiltration. The hepatic echotexture is diffusely coarse but homogeneous. The liver margins remain smooth. No focal hepatic lesion or intrahepatic biliary dilatation is identified. The portal vein demonstrates normal hepatopetal flow on Color Doppler examination.
Report Line
The liver is mildly enlarged, measuring approximately 155 mm at the midclavicular line (MCL). There is marked diffuse increase in hepatic echogenicity compared with the right renal cortex, consistent with Grade III hepatic steatosis (fatty liver). Marked posterior acoustic beam attenuation is present with poor visualization of the intrahepatic vessels and diaphragm. No focal hepatic lesion or intrahepatic biliary dilatation is identified. Portal venous flow is normal on Color Doppler imaging.
Impression
Mild hepatomegaly with diffuse severe hepatic steatosis (Fatty Liver Grade III).
Key Learning Points
- Grade I hepatic steatosis is characterized by mild diffuse increase in hepatic echogenicity with preserved visualization of the diaphragm and intrahepatic vessels.
- Hepatomegaly commonly accompanies diffuse fatty infiltration, particularly in metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD).
- Ultrasound is the preferred first-line imaging modality for detecting fatty liver and assessing liver size.
- Common risk factors include obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, alcohol use, and non-alcoholic fatty liver disease (NAFLD).
- Color Doppler usually demonstrates normal portal venous flow in uncomplicated fatty liver.
- Grade I steatosis is potentially reversible with weight loss, dietary modification, regular exercise, and control of metabolic risk factors.
- Ultrasound cannot reliably differentiate simple steatosis from steatohepatitis or accurately stage hepatic fibrosis; further evaluation may be required when clinically indicated.
Recommendation
Clinical and laboratory correlation is recommended. Correlation with liver function tests, fasting blood glucose, HbA1c, and lipid profile should be considered. Lifestyle modification including weight reduction, regular exercise, and dietary changes is advised. Follow-up ultrasound may be performed after 6–12 months or earlier if clinically indicated. Consider elastography if there is clinical suspicion of hepatic fibrosis.
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