Case Study

Focal Fatty Sparing

Focal Fatty Sparing is a benign imaging finding characterized by localized areas of normal liver parenchyma within a diffusely fatty infiltrated liver. These regions appear relatively hypoechoic compared with the surrounding steatotic liver and commonly occur adjacent to the gallbladder fossa, porta hepatis, or falciform ligament. Recognition of focal fatty sparing is important because it may mimic focal hepatic lesions such as tumors or metastases, although it demonstrates normal vascular architecture and lacks mass effect.

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Whole Abdomen & Pelvis Sonography

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Technique: Examination performed using a convex 3.5–5 MHz transducer. Longitudinal and transverse planes of the abdomen were evaluated. Color Doppler assessment of hepatic and portal vessels was performed. Pelvic and post-void images were obtained. Patient was fasting for 6–8 hours.
Prior studies: No prior imaging available.
Clinical history: Routine sonographic evaluation.

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Liver: Liver appears enlarged and demonstrates diffuse increased echogenicity consistent with fatty infiltration. A focal hypoechoic area is seen adjacent to the gallbladder fossa / periportal region, maintaining normal vascular architecture and without mass effect, consistent with focal fatty sparing. No focal hepatic mass lesion is identified. Intrahepatic biliary radicles are not dilated. Portal vein is normal in caliber with normal hepatopetal flow. Gall Bladder: Gall bladder is normal in size, shape, and echotexture. No calculus, mass, or sludge is seen. Wall thickness is normal. Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length. Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen. Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen. Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen. Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen. Rt. Ureter: Right ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Lt. Ureter: Left ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant. Prostate: Prostate volume is within normal limits. Echotexture appears homogeneous. Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: No abdominal lymphadenopathy identified. Visualized bowel loops are unremarkable. Appendix is not visualized; no sonographic evidence of acute appendicitis. Bilateral inguinal regions are unremarkable without hernia or significant lymphadenopathy.

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Measurement Summary:

Liver: 159 mm	Spleen: 102 mm
RK: 98 mm	LK: 106 mm
Prostate: 14.5 mL

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Impression: Diffuse fatty liver with focal fatty sparing with hepatomegaly.
No focal hepatic mass lesion identified.br Otherwise unremarkable ultrasound study of the abdomen and pelvis.

Recommendation: Clinical correlation advised.

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Limitations / Technical Factors: Ultrasound evaluation may not detect subtle bowel or early parenchymal abnormalities. Correlation with clinical findings is recommended.

• This report and accompanying images are not valid for medico-legal purposes.

Focal Fatty Sparing – Ultrasound Diagnosis and Scanning Technique

1. Focal fatty sparing refers to:
A. Focal liver abscess
B. Area of normal liver within a fatty liver
C. Hepatic cyst
D. Metastatic lesion

2. Focal fatty sparing is most commonly seen in:
A. Normal liver
B. Cirrhotic liver
C. Diffuse hepatic steatosis
D. Polycystic liver disease

3. On ultrasound, focal fatty sparing appears:
A. More hypoechoic than surrounding fatty liver
B. Completely anechoic
C. Markedly calcified
D. Strongly shadowing

4. A common location for focal fatty sparing is:
A. Around the gallbladder fossa
B. Renal cortex
C. Pancreatic tail
D. Splenic hilum

5. Another frequent site is:
A. Urinary bladder
B. Porta hepatis region
C. Adrenal gland
D. Appendix

6. A key feature suggesting focal fatty sparing is:
A. Mass effect on vessels
B. Distortion of liver capsule
C. Normal vessels traversing the area
D. Thick calcified rim

7. Color Doppler typically shows:
A. Chaotic neovascularity
B. No blood flow
C. Normal vascular pattern
D. Arteriovenous malformation

8. Focal fatty sparing may mimic:
A. Hepatic tumor or metastasis
B. Kidney stone
C. Pleural effusion
D. Ovarian cyst

9. The absence of which feature supports focal fatty sparing?
A. Portal veins
B. Mass effect
C. Normal parenchymal architecture
D. Blood flow

10. Correct recognition of focal fatty sparing helps:
A. Avoid unnecessary biopsy or follow-up
B. Diagnose gallstones
C. Confirm cirrhosis
D. Detect ascites

Answer Key:

1-B, 2-C, 3-A, 4-A, 5-B,
6-C, 7-C, 8-A, 9-B, 10-A