Differential Diagnosis for Liver Involvement in Sarcoidosis

Given the liver ultrasound (US) findings of a normal-sized liver with a nonuniform heterogeneous fracture macro pattern, which could be indicative of partial fatty infiltration of the liver versus liver parenchymal disease in a patient with sarcoidosis, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Sarcoidosis-related liver involvement: This is the most likely diagnosis given the patient's known history of sarcoidosis. Sarcoidosis can affect the liver, leading to granulomatous inflammation, which may present as a nonuniform heterogeneous pattern on ultrasound due to the scattered nature of the granulomas throughout the liver parenchyma.

• Other Likely Diagnoses

  • Fatty Liver Disease (Steatosis): The ultrasound findings could also suggest partial fatty infiltration, which is a common condition that can coexist with sarcoidosis. Fatty liver disease can present with a similar heterogeneous pattern on ultrasound due to the uneven distribution of fat within the liver.
  • Viral Hepatitis: Although less directly related to the ultrasound findings, viral hepatitis (e.g., hepatitis B or C) can cause liver parenchymal disease and should be considered, especially if there are risk factors or other clinical indicators.

• Do Not Miss Diagnoses

  • Hepatic Malignancy: Although less likely, it is crucial not to miss a diagnosis of hepatic malignancy, such as hepatocellular carcinoma, which can present with heterogeneous liver patterns on imaging. The presence of sarcoidosis does not exclude the possibility of cancer.
  • Infiltrative Liver Diseases (e.g., Lymphoma): Other infiltrative diseases like lymphoma can affect the liver and present with non-specific ultrasound findings similar to those described. Given the potential severity of these conditions, they should not be overlooked.

• Rare Diagnoses

  • Primary Biliary Cholangitis (PBC) or Primary Sclerosing Cholangitis (PSC): These autoimmune liver diseases can cause heterogeneous liver patterns due to inflammation and fibrosis but are less common and might not be the first consideration without specific clinical or laboratory indicators.
  • Amyloidosis: A rare condition that can involve the liver and present with non-specific findings on imaging, including a heterogeneous pattern. It is less likely but should be considered in the differential diagnosis, especially if other systemic symptoms are present.