Shelby Rhoda 1

Research Paper

Sonography: Hepatic Steatosis

Shelby Rhoda

DMS 393

Fall 2015

CERTIFICATE OF AUTHORSHIP: I certify that I am the author of this research paper. I have

cited all of the sources from which I used data, ideas, or words (quoted or paraphrased). I also

certify that this paper was prepared by me specifically for this course.

Signature: Shelby Rhoda Date: 11/24/2015

 Shelby Rhoda 2

Abstract

Hepatic steatosis is a prevalent disease of the liver common in America. This case study is a

report of a patient referred for sonography due to abnormal levels of liver enzymes, a history of

Hepatitis C, and uncontrolled diabetes mellitus. The ultrasound revealed a liver of increased

echogenicity compatible with hepatic steatosis as well as enlarged size of the spleen. This report

will discuss sonographys role in helping the physician to diagnosis hepatic steatosis. Common

sonographic appearances with hepatic steatosis will also be discussed in comparison and contrast

to this case as well as other cases dealing with this pathology.

Keywords

Sonography, hepatic steatosis, liver enzymes, alcohol

Hepatic steatosis is a liver disease most commonly appearing in Caucasian men in America.

Hepatic steatosis is a reversible disorder of metabolism that results in a build-up of triglycerides.

A common cause of hepatic steatosis is excessive alcohol intake which produces a fatty liver by

stimulating lipolysis. Fatty infiltration of the liver is a metabolic disorder and can cause the

patients metabolic panel to be abnormal such as the liver function tests. A case of hepatic

steatosis is presented and discussed, illustrating the role of sonography in evaluation and

diagnosis.

Case history

An adult man was ordered an ultrasound for elevated liver enzymes. The patient stated that he

consistently drank approximately six cans of beer a week. The patient has uncontrolled diabetes

mellitus and a history of Hepatitis C which were both confirmed with lab results during his stay
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in the hospital. Elevated liver enzymes such as bilirubin, AST, and ALT can indicate jaundice,

liver damage, fatty liver, and hepatitis along with several other clinical findings.1

Sonographic Findings

An abdominal complete ultrasound was ordered because of elevated liver function enzymes.

Sagittal and transverse images were taken of the right and left lobe of the liver. The overall

texture of the liver appeared increased in echogenicity but the liver did not appear enlarged

(figure 1). The main portal vein appeared patent and showed hepatopetal portal venous flow

(figure 2). The liver length measured 17.55 cm. The liver appeared hyperechoic to the right

kidney with coarse echotexture (figure 3). The spleen was also imaged in sagittal and transverse

and measured enlarged approximately 17 cm (figure 4). The spleen appeared homogeneous with

medium level shades of gray.

Figure 1: Sagittal image of the liver showing increased echogenicity with coarse echotexture.
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Figure 2: A spectral Doppler showing the main portal vein with hepatopetal flow demonstrating

MPV patency.

Figure 3: An inferior, sagittal image taken of the liver compared to the right kidney showing the

hyperechoic tissue of the liver compared to the echogenicity of the kidney parenchyma.
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Figure 4: Sagittal image taken of the spleen showing it measuring in length of 16.63 cm with

homogeneous echotexture and medium level shades of gray.

Discussion

Hepatic steatosis is described as abnormal build-up of triglycerides in parenchymal cells. This

causes a fatty change that is often seen within the liver because it is a major organ of metabolism,

especially fat metabolism.2

Diagnosis

The findings of this ultrasound were said by the physician to be consistent with hepatic

steatosis and splenomegaly. The differential diagnosis to be ruled out was cirrhosis.

Mild hepatic steatosis appears sonographically as minimal diffuse increase in hepatic

echogenicity with normal intrahepatic vessels.3 This description is consistent with this case study

and the ultrasound findings of the liver and portal venous system. Hepatic steatosis is often

characterized with the clinical findings such as a low and steady increase in liver function tests

and can also lead to a loss of hepatic functions and cirrhosis.4 The incidence of alcoholic hepatic

steatosis is difficult to pinpoint because of varying factors. However, the risk of liver disease
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does increase with the amount of alcohol intake. Only 1 in 5 alcohol abusers develop alcohol

related liver diseases such as hepatic steatosis, hepatitis, or cirrhosis.5 This case is similar in the

fact that the patient presented with elevated enzymes indicating liver disease with a history of

alcohol use. Non-alcoholic hepatic steatosis is a common liver disease in America affecting

pediatric and adult patients. This is dissimilar to the case presented because this patient has a

history of alcohol use. An important thing for sonographers to learn in studying hepatic steatosis

on ultrasound is to properly gather and pay attention to related patient history obtained during

patient interview. An important point to be made while scanning is to distinctly check the portal

system because hepatic steatosis can lead to portal hypertension. Treatment for this pathology is

usually correcting the causative agent which may reverse the process of fatty liver disease.

However, fatty infiltration of the liver can be a precursor for chronic liver disease and will need

to be followed up consistently with ultrasound.3

Conclusion

This case compared with other documented cases by demonstrating similar clinical findings such

as elevated liver enzymes and similar patient history. This case was different compared to cases

where hepatic steatosis was documented with non-alcoholic patients. Sonographers will find

when imaging patients with a fatty liver that the liver texture appears increased in echogenicity

and difficult to penetrate. It is important for sonographers to evaluate surround organs such as

pancreas and spleen for effects that portal hypertension secondary to fatty liver can cause. The

treatment for hepatic steatosis is to remove the causative agent such as alcohol in this instance.

Other examples would be to control diabetes or encourage obese patients to lose weight. This

patient was encouraged to stop drinking because his condition can lead to chronic liver disease

such as cirrhosis of the liver.

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REFERENCES

1. Curry, Reva. Tempkin, Betty. Sonography: Introduction to Normal Structure and Function.

Third edition. St. Louis, MO: Saunders; 2011.

2. Kumar V, Abbas A, Fausto N, Aster J. Robbins And Cotran Pathologic Basis Of Disease,

Professional Edition [e-book]. Philadelphia, PA: Saunders; 2009. Available from: eBook

Collection (EBSCOhost), Ipswich, MA. Accessed November 23, 2015

3. Carol Rumack, Stephanie Wilson, J. Charboneau, Deborah Levine. Diagnostic Ultrasound.

Fourth edition. Philadelphia, PA: Mosby, Inc.; 2011.

4. Blann A, Ahmed N. Blood Science: Principles And Pathology [e-book]. Chichester, West

Sussex, UK: Wiley-Blackwell; 2013. Available from: eBook Collection (EBSCOhost), Ipswich,

MA. Accessed November 23, 2015.

5. Fairbanks, Kyrsten D. Alcoholic Liver Disease. Lyndhurst, OH: The Cleveland Clinic

Foundation; 2012.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/alcoholic-

liver-disease/