title: A case of porphyria cutanea tarda of the liver exhibiting multifocal macrovesicular steatosis in the background of microvesicular steatosis, probably caused by uneven iron accumulation.
abstract: A 61-year-old man with chronic hepatitis B and a history of alcohol overconsumption was admitted to our hospital for the scrutiny of multiple echogenic liver nodules. CT and hepatobiliary phase of gadoxetate-enhanced MR imaging revealed no nodular lesions. Quantitative fat fraction images and R2* map of MR imaging suggested homogeneous steatosis and uneven iron deposition in the liver, namely moderately and severely elevated R2* values at the nodules and surrounding background liver, respectively. Biopsy specimens showed macrovesicular fatty liver and less iron deposition at the echogenic nodules, and microvesicular fatty change and more prominent iron deposition at the surrounding liver tissue. The patient's urinary uroporphyrin level was elevated, and the final diagnosis of porphyria cutanea tarda was made. In patients with history of excessive alcohol intake or viral hepatitis, echogenic nodules on ultrasonography along with radiological evidence of absence of space occupying lesions, and presence of excessive intrahepatic fat and iron, might suggest a possible diagnosis of porphyria cutanea tarda.
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Marie
authors.initials: M
authors.lastname: Nishiyama
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Shinagawa
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Morita
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Urakawa
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Fujimitsu
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shakado
authors.affiliation: Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hamada
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. kengo@fukuoka-u.ac.jp.
authors.forename: Kengo
authors.identifier: 0000-0001-8530-2849
authors.initials: K
authors.lastname: Yoshimitsu
mesh_terms: D000437:Alcoholism / Q000150:complications; D003287:Contrast Media; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000378:metabolism; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D007501:Iron / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017119:Porphyria Cutanea Tarda / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007501:Iron
keywords: Fat; Iron; Liver; MRI; Porphyria cutanea tarda