Presumed hepatic pseudolipoma detected as a small hepatic surface lesion: multimodality imaging findings

Hepatic pseudolipomas are uncommon benign lesions located on or near the liver capsule which are thought to arise from a detached epiploic appendage that becomes trapped near Glisson's capsule. Because these lesions may appear as small hepatic or perihepatic nodules, they can mimic primary or metastatic hepatic tumors on screening imaging. Here, we report the case of a 55-year-old asymptomatic man with no relevant medical history who was referred after routine health-screening ultrasonography revealed a 10 × 8-mm hyperechoic lesion adjacent to the surface of liver segment VI. Liver function tests were normal, hepatitis B and C viral markers were negative, and tumor markers, including carcinoembryonic antigen, carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II, were within the normal ranges. Dynamic ultrasonography demonstrated that the lesion was located along the hepatic capsule, rather than within the deep hepatic parenchyma. Computed tomography showed a well-demarcated hepatic surface lesion with central calcification and surrounding fat attenuation, without any arterial, portal venous, or delayed enhancement. Gadoxetate disodium-enhanced magnetic resonance imaging revealed fat-containing signal characteristics, no hepatobiliary-phase uptake, and no diffusion restriction. The integrated multimodal imaging findings supported a diagnosis of presumed hepatic pseudolipoma, likely originating from a detached epiploic appendage. Recognition of this benign hepatic tumor mimic may help to avoid unnecessary biopsy or surgery.