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INTERPRETATION OF FIGURE 1 (SEE PAGE 344)

  1. Top of page
  2. INTERPRETATION OF FIGURE 1 (SEE PAGE 344)
  3. DIAGNOSIS: NONALCOHOLIC STEATOHEPATITIS
  4. REFERENCES

Figure 1 is a late phase bolus enhancement CT showing an inhomogenously attenuated liver parenchyma and mild splenomegaly. The liver parenchyma demonstrates many ill-defined small round areas of low attenuation. The unenhanced CT of the liver also shows inhomogeneous density, but no nodular lesion is recognized. The size of the liver is enlarged. This CT of the liver is not diagnostic, but suggests possible cirrhotic changes. Nodules in liver cirrhosis are not recognized by a normal CT, unless there is an iron overload.

DIAGNOSIS: NONALCOHOLIC STEATOHEPATITIS

  1. Top of page
  2. INTERPRETATION OF FIGURE 1 (SEE PAGE 344)
  3. DIAGNOSIS: NONALCOHOLIC STEATOHEPATITIS
  4. REFERENCES

An endoscopy of the stomach found an ulcer in the prepyloric region, and a biopsy found this to be an ulcerating carcinoma. A gastrectomy was carried out. The liver surface was mildly nodular, and a wedge biopsy was performed which showed mascrovesicular steatosis, fibrosis and incomplete nodule formation (Fig. 2). The histology mimics that of alcoholic liver disease. Nonalcoholic steatohepatitis (NASH), which is also called nonalcoholic fatty liver (NAFL), was first described by Thaler in 1969 as ‘steatotische hepatitis’1 but this disorder has only recently become an established liver disease. It is now recognized as a significant form of chronic liver disease and is frequently the underlying cause of cryptogenic cirrhosis. By definition, there is lack of significant alcohol intake by the patient, and neither clinical evaluation nor laboratory study ensures the diagnosis. Liver biopsy is considered the gold standard for diagnosis.2 More women than men are affected, and 90% of patients are obese, diabetic, or both. On physical examination, hepatomegaly is present in 75% of patients, and elevated serum aminotransferase levels are present in 90% of cases. Liver biopsy shows macrovesicular steatosis with lobular inflammation, and Mallory bodies are seen in 80% of specimens. Perisinusoidal, centrilobular and/or septal fibrosis are seen in 70%, and cirrhosis is evident in 15% of cases.3 NASH is uncommon in Japan in comparison with with Western countries.

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Figure 2.  Wedge biopsy of the liver demonstrating macrovesicular steatosis, hyaline bodies and septal and perisinusoidal fibrosis. Incomplete nodule formation is evident.

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REFERENCES

  1. Top of page
  2. INTERPRETATION OF FIGURE 1 (SEE PAGE 344)
  3. DIAGNOSIS: NONALCOHOLIC STEATOHEPATITIS
  4. REFERENCES