Metastases: This is often the first consideration due to the high prevalence of liver metastases from various primary cancers, such as colorectal, breast, lung, and pancreatic cancer. The appearance of multiple scattered hypodensities on CT is consistent with metastatic disease.

Hemangiomas: These are benign liver lesions that can appear as hypodense on CT scans, especially if they are not filled with contrast. They are common in the general population and can be multiple.
Focal Fatty Change or Focal Fatty Sparing: These conditions can cause areas of the liver to appear hypodense on CT due to variations in fat distribution within the liver.
Simple Cysts: While typically anechoic on ultrasound, simple cysts can appear as hypodense lesions on CT scans, especially if they are small or if the CT scan is performed without contrast.

Abscesses: Liver abscesses can present as hypodense lesions and are critical to identify due to their potential for serious complications, including sepsis and death if not promptly treated.
Hepatic Involvement in Lymphoma: Although less common, lymphoma can involve the liver and present with multiple hypodense lesions. Missing this diagnosis could lead to delayed treatment of a potentially curable condition.
Intrahepatic Cholangiocarcinoma: This primary liver cancer can present with multiple hypodense lesions and has a poor prognosis if not diagnosed and treated early.

Biliary Hamartomas (Von Meyenburg Complexes): These are benign biliary malformations that can appear as multiple small hypodense lesions on CT scans.
Hepatic Lymphangiomas: Rare benign lesions that can cause multiple hypodense areas in the liver due to their cystic nature and low density.
Polycystic Liver Disease: While often identified by the presence of numerous cysts, in some cases, the cysts can be small and uniform, appearing as scattered hypodensities on CT scans.