Differential Diagnosis for Focal Steatosis near Falciform Ligament and Subcentimeter Cysts

• Single Most Likely Diagnosis
  • Focal Fatty Liver: This condition is characterized by the accumulation of fat in a specific area of the liver, which can appear as focal steatosis on imaging. The location near the falciform ligament and the presence of a few subcentimeter cysts can be consistent with this diagnosis, as focal fatty liver can sometimes be associated with benign cysts.
• Other Likely Diagnoses
  • Focal Fatty Sparing: This is a condition where there is a focal area of normal liver tissue surrounded by fatty liver. It can appear similar to focal fatty liver on imaging but represents a different pathophysiological process. The presence of subcentimeter cysts does not rule out this diagnosis.
  • Liver Hemangioma with Fatty Infiltration: Hemangiomas are benign liver tumors that can sometimes contain fat, especially if they are large or if there is associated liver disease. The subcentimeter cysts could represent areas of cystic degeneration within a hemangioma.
• Do Not Miss Diagnoses
  • Hepatocellular Carcinoma (HCC) with Fatty Metamorphosis: Although less common, HCC can occasionally present with areas of fatty metamorphosis, mimicking benign fatty liver disease. The presence of subcentimeter cysts could be misleading, but given the potential severity of HCC, it is crucial not to miss this diagnosis.
  • Metastatic Disease: Metastases to the liver can have a variable appearance on imaging, including fatty components and cystic areas, especially if they originate from tumors known to have these characteristics (e.g., mucinous carcinomas).
• Rare Diagnoses
  • Angiomyolipoma with Fatty Component: Although rare in the liver, angiomyolipomas can contain fat and occasionally present with cystic components. They are usually benign but can be problematic if they bleed.
  • Inflammatory Hepatocellular Adenoma: These rare benign liver tumors can contain fat and sometimes have cystic areas. They are important to recognize because they can have a risk of bleeding and, in rare cases, malignant transformation.