Clinical Presentation

A 54-year-old man presents for further work-up of an incidental finding on abdominal ultrasound.

(A) Ultrasound shows diffuse, coarse echogenicity of the liver parenchyma (arrowhead) compared with the normal-appearing kidney parenchyma (arrow).(B) T2-weighted magnetic resonance imaging (MRI) shows a homogeneously hypointense liver (arrow) compared with the normal-appearing spleen (arrowhead).

Differential Diagnosis

• Hemochromatosis (primary): The top diagnosis, it classically causes markedly decreased signal intensity (SI) on T2-weighted MRI and a coarsely echogenic liver on ultrasound due to hepatic fibrosis.

• Fatty infiltration of the liver: