Ummara Siddique Umer, Shahjehan Alam, Hadia Abid, Naila Shoaib Orakzai, Aman Nawaz Khan, Syed Ghulam Ghaus, Seema Gul, Sadia Gul, Abdullah Safi.
Unusual hepatic lesion with fat fluid level - imaging findings and review of literature.
Pak J Radiol Jan ;27(4):404-7.

There are a variety of liver lesions, both benign and malignant, which may contain fat. The benign lesions range from focal fatty change to hepatocellular adenoma and teratoma. Malignant tumors that can contain fat primarily include hepatocellular carcinoma and primary and metastatic liposarcoma. The imaging characteristics of a lesion, enhancement pattern and pattern of intratumoral fatty change are helpful in narrowing the differential diagnosis. We present an unusual case of a 50 year old female with hepatic lesion having fat fluid level on imaging. She was investigated using 128-slice Multidetector Computed tomography (MDCT) scanner and 3mm reconstructed images in soft tissue window were viewed on vitrea workstation. The lesion had a large fat fluid level and showed no post contrast enhancement. Furthermore, MRI was done on 1.5 tesla GE machine, which confirmed the diagnosis. This case report focuses on atypical presentation of hepatic hydatid with fat fluid level and review of literature for the spectrum of imaging findings. Conclusion: Hepatic hydatid cysts can show atypical pattern of fat fluid level. This case report showed demonstrable fat fluid level within hepatic hydatid cyst on CT imaging, which on further imaging by MRI, showed hydatid membranes in the dependent fluid. Clinical relevance: 128 slice MDCT with dynamic protocol, its high resolution and multiplanar imaging plays an instrumental role in diagnosis of hepatic lesions. However, sometimes in very rare cases, further imaging with MRI is required. Although the presence of fat can be demonstrated with computed tomography or ultrasound, magnetic resonance imaging is the most specific imaging technique for demonstration of both microscopic and macroscopic fat. Key words: Multidetector Computed Tomography (MDCT), Magnetic Resonance Imaging (MRI), Hepatic lesion, hydatid cyst, Fat containing hepatic lesion, fat fluid level.

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