Hepatic Metastasis: This is often the most common diagnosis for multiple hypoattenuating liver lesions with peripheral enhancement, especially in the context of a known primary malignancy. The peripheral nodular enhancement pattern is characteristic of metastatic disease.

Hepatic Abscess: Although typically presenting with more pronounced symptoms such as fever and pain, hepatic abscesses can appear as hypoattenuating lesions with peripheral enhancement. The size and location can vary.
Hemangioma: While typically showing characteristic early peripheral nodular enhancement with centripetal fill-in on delayed images, some hemangiomas can present atypically, especially if they are smaller or have undergone thrombosis or fibrosis.
Focal Fatty Change or Focal Fatty Sparing: These can appear as hypoattenuating areas but usually do not show significant enhancement. However, in some cases, especially with fatty sparing, the appearance can be atypical.

Hepatocellular Carcinoma (HCC): Especially in patients with risk factors such as cirrhosis or hepatitis B/C infection, HCC can present as a hypoattenuating lesion with peripheral enhancement. Missing this diagnosis could have significant implications for patient management and prognosis.
Infectious Diseases (e.g., Echinococcal Cyst): In endemic areas, parasitic infections like echinococcosis can present with cystic lesions in the liver that may show peripheral enhancement, especially if they become infected.
Cholangiocarcinoma: Although less common, intrahepatic cholangiocarcinoma can present as hypoattenuating masses with peripheral enhancement, particularly if they are associated with obstructive jaundice or other signs of biliary obstruction.

Biliary Hamartomas (Von Meyenburg Complexes): These are benign biliary malformations that can appear as multiple small hypoattenuating lesions but typically do not show significant enhancement.
Hepatic Lymphangioma: A rare benign lesion that can present as a hypoattenuating mass with possible enhancement, though this is less common in the liver compared to other locations.
Peliosis Hepatis: A rare condition characterized by the presence of blood-filled cavities within the liver, which can appear as hypoattenuating lesions. It is often associated with certain medications, infections, or malignancies.