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+A 46-year-old Caucasian woman with type 2 diabetes mellitus and bipolar disorder presented to our emergency department with vague abdominal symptoms and vomiting.
+Her pertinent history includes left below knee amputation and right toes amputation for complications secondary to diabetic neuropathy.
+At the time of admission, she was undergoing care for an infected diabetic ulcer of her right foot.
+Of note, she did not have a history of CAPD or a history of renal disease: creatinine 1.23 mg/dL, blood urea nitrogen (BUN) 16 mg/dL.
+Her blood glucose levels were poorly controlled via subcutaneous insulin injection; she reported a range of 400 to 500 mg/dL at home (due to poor drug compliance).
+Her blood glucose levels were decreased to a range of 175 to 378 mg/dL after implementation of a stricter insulin regimen upon admission.
+A non-contrast CT scan showed confluent, bilobar geographic regions of hypoattenuation in a subcapsular distribution throughout her liver (Fig.1).
+A MRI liver protocol was performed for further evaluation of these indeterminate findings to assess for possible vascular etiology as areas of infarction could also be possible in this patient.
+In-phase gradient echo images demonstrated hyperintense foci in her liver in a distribution corresponding to the hypoattenuating regions seen on CT.
+On the opposed-phase sequence, there was loss in signal within these areas indicating the presence of intracellular fat and water (Fig.2).
+In addition, these areas were hypointense to the remaining hepatic parenchyma on the fat suppression MR sequences, confirming presence of fat and thus establishing a diagnosis of SHS.
+Furthermore, a follow-up CT of her abdomen and pelvis was performed 3 months later, which showed near complete resolution of these findings (Fig.3).
+Of note, stricter glucose control had decreased her average blood glucose level to below 200 mg/dL.