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Radiology · Liver imaging: focal fatty sparing
Sample itemA patient with diffuse fatty liver on ultrasound has a hypoechoic, geometric area next to the gallbladder fossa with no mass effect and normal vessels passing through it. What is the explanation?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Focal sparing of fat from aberrant venous drainage
In steatosis, areas drained by aberrant gastric or cystic veins can escape fat deposition, and they look relatively hypoechoic with non-spherical borders and no vessel displacement. The gallbladder fossa and segment IV are typical sites.
Option by option
A. Focal sparing of fat from aberrant venous drainage (correct)
Correct. Geometric sparing near the gallbladder without mass effect is a classic pseudolesion.
B. A hepatic haemangioma
A haemangioma is usually echogenic.
C. A metastasis
A metastasis would distort vessels and have a rounded shape.
D. A hepatocellular carcinoma
HCC would show mass effect and typical contrast behaviour.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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