1. 78 Generalized Decreased
Attenuation of the Liver

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GI 78-1 Fatty infiltration in cirrhosis.
Generalized decrease in the attenuation value
of the liver (far less than that of the spleen).
The portal veins appear as high-density
structures surrounded by a background of
low-density hepatic fat.

4. • Fig GI 78-2 Patchy fatty infiltration in cirrhosis. The right (R)
and caudate (c) lobes of the liver are replaced by fat to a
degree that makes the density almost equal to that of the
gallbladder (G). The medial segment of the left hepatic lobe
has a higher CT density but contains foci of low
attenuation. The spleen is large, and the caudate lobe is
prominent. The portal vein (arrows) courses normally
through the center of the right hepatic lobe, distinguishing
fatty infiltration from a low-density tumor.122

5. • Fig GI 78-3 Regenerating nodules in cirrhosis. Multiple
nodules of attenuation equal to that of normal liver are
seen superimposed on a background of low-
attenuation fatty infiltration. Note the calcification in
the pancreas caused by chronic pancreatitis in this
patient, a chronic alcoholic.

6. • Fig GI 78-4 Budd-Chiari syndrome. Contrast scan
of a woman with a coagulation disorder and
hepatic vein thrombosis shows the characteristic
mosaic pattern of peripheral low attenuation in
both the right and left hepatic lobes. The liver is
enlarged with relatively marked hypertrophy of
the caudate lobe, which has a uniform
attenuation.129

7. • Fig GI 78-5 Budd-Chiari syndrome. Classic flip-flop
pattern of hepatic contrast enhancement. (A)
Initially, the normally enhancing central part of
the liver, including the caudate lobe (CL) and part
of the lateral segment of the left lobe (LS),
appears hyperdense relative to the periphery of
the liver, which enhances more slowly. (B) Later,
as the contrast material washes out centrally and
accretes peripherally, the central region appears
relatively hypodense. Note the thrombus in the
hepatic veins (arrows). (A, ascites.)139

8. • Fig GI 78-6 Congestive heart failure. (A) Early
bolus-enhanced scan shows dense retrograde
hepatic venous opacification. (B) Scan
obtained during the vascular phase shows
diffusely mottled hepatic enhancement.140

9. • Fig GI 78-7 Amyloidosis. Diffusely enlarged
liver with generalized decreased
attenuation.141