27998312 Visualization

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