An Unusual Presentation of Multifocal Fatty Lesions in the Liver

A case of a 40-years old female patient with a known history of pancreatic neuroendocrine tumor (NET) who presented with multiple hypodense lesions in the liver with central foci of hyperdensity on dynamic contrast enhanced CT. Due to her NET background, a negative somatostatin PET/CT followed. Lastly, MRI evaluation of the lesions was pursued and the lesions were proven as fat containing lesions.

Resolution of our case unveiled ahypodense rim of fatty infiltration suggesting metastatic insulinoma. The unusual pathophysiology will be discussed.

Conclusion: focal hepatic steatosis caused by local effects of insulin can present as focal rim surrounding metastatic insulinoma.