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Hepatic Subcapsular Steatosis in Response to Intraperitoneal Insulin Delivery: CT Findings and Prevalence

Korosh Khalili1,2, Frederick P. Lan1, Anthony E. Hanbidge1, Derek Muradali1, Dmitrios G. Oreopoulos3 and Ian R. Wanless4

1 Department of Medical Imaging, University Health Network and Mount Sinai Hospitals, 200 Elizabeth St., Toronto, Ontario M4G 2C4, Canada.
2 Department of Medical Imaging, 3-964, Princess Margaret Hospital, University Health Network, 610 University Ave., Toronto, Ontario M5G 2M9, Canada.
3 Department of Internal Medicine, University Health Network and Mount Sinai Hospitals, Toronto, Ontario M4G 2C4, Canada.
4 Department of Laboratory Medicine and Pathobiology, University Health Network and Mount Sinai Hospitals, Toronto, Ontario M4G 2C4, Canada.



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  		Fig. 1. —Photograph of gross specimen of liver from 54-year-old man with history of chronic renal failure who received intraperitoneal insulin. Note visible geographic areas of fatty infiltration (asterisks) in subcapsular location.

 


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  		Fig. 2. —Photomicrograph of histopathologic specimen of percutaneous core needle biopsy of subcapsular lesion in 41-year-old woman shows hepatic fatty deposition within vacuolar spaces (white arrows). Black arrow marks direction of liver capsule. Note increasing concentration of fat toward capsular surface of liver. (H and E)

 


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  		Fig. 3A. —61-year-old man with hepatic subcapsular steatosis. Axial contrast-enhanced CT scan shows multiple discrete hypoattenuating nodules (arrowheads) within liver in subcapsular locations.

 


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  		Fig. 3B. —61-year-old man with hepatic subcapsular steatosis. Transverse sonogram (corresponding to A) obtained through left lobe depicts nodules (arrowheads) as echogenic.

 


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  		Fig. 4A. —63-year-old woman with hepatic subcapsular steatosis. Axial contrast-enhanced CT scan shows thin subcapsular low-attenuation rind (arrowheads) in right lobe of liver.

 


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  		Fig. 4B. —63-year-old woman with hepatic subcapsular steatosis. Sonogram (corresponding to A) shows abnormality that appears as echogenic rind (arrowheads).

 


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  		Fig. 5A. —61-year-old man with hepatic subcapsular steatosis. Axial contrast-enhanced CT scan shows typical nodular form of hepatic subcapsular steatosis (arrows). Peritoneal dialysis and therefore intraperitoneal insulin were stopped immediately after scan because of peritonitis.

 


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  		Fig. 5B. —61-year-old man with hepatic subcapsular steatosis. In follow-up CT scan obtained 4 months after A, some nodules (arrows) are smaller, whereas others have resolved.

 


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  		Fig. 6. —70-year-old woman with severe hepatic subcapsular steatosis. Axial contrast-enhanced CT scan shows large confluent subcapsular low-attenuation regions (arrowheads).

 

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