title: Multifocal Nodular Fatty Infiltration of the Liver: A Case Report of a Challenging Diagnostic Problem.
abstract: BACKGROUND
  Fatty infiltration of the liver usually has a diffuse pattern, but in very rare cases it presents as multiple focal lesions of the liver, mimicking metastases. A correct diagnosis is crucial to address prognosis and eventual treatment.
  
  
  METHODS
  We present the case of a completely fit and asymptomatic patient referred for multiple bilateral liver metastases of unknown origin. She had no previous history of malignancy. She was extensively investigated with all locally available methods, including ultrasound scan, computed tomography, magnetic resonance imaging, upper and lower gastrointestinal endoscopy, and diagnostic laparoscopy. Imaging-guided biopsy and laparoscopic biopsy confirmed the diagnosis of multifocal fatty infiltration of the liver.
  
  
  CONCLUSIONS
  The diagnosis of this condition can be challenging and an accurate initial clinical history must be part of a thorough clinical examination. Multimodal imaging is mandatory, but diagnostic laparoscopy with direct macrobiopsy may be necessary to clear all doubts.
authors.affiliation: Department of Surgery, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom.
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: Tebala
authors.affiliation: Department of Radiology, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom.
authors.forename: Anees
authors.initials: A
authors.lastname: Jwad
authors.affiliation: Department of Surgery, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom.
authors.forename: Abdul Quyyum
authors.initials: AQ
authors.lastname: Khan
authors.affiliation: Department of Pathology, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom.
authors.forename: Ervine
authors.initials: E
authors.lastname: Long
authors.affiliation: Department of Radiology, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom.
authors.forename: Guy
authors.initials: G
authors.lastname: Sissons
mesh_terms: D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis; D008875:Middle Aged