Focal Fatty Change After Total Pancreatectomy Mimics Hypervascular Liver Tumor.

Focal fatty change (FFC) can exhibit various patterns. Therefore, multifocal cases may require differentiation from metastatic liver tumors because the diagnosis is challenging in case of a history of treatment for malignant tumors. Herein, we report the case of a 65-year-old man with FFC who underwent total pancreatectomy for advanced intraductal papillary mucinous carcinoma. In this case, regular replacement of the percutaneous transhepatic cholangial drain was performed for postoperative anastomotic stenosis. The FFC showed a multifocal pattern with arterial-phase hyperenhancement and washout patterns; therefore, differentiation from not only metastatic liver tumors but also from hypervascular liver tumors including hepatocellular carcinoma was required. This case report highlights that although FFC can have a variety of imaging patterns; it can present arterial-phase hyperenhancement and washout patterns.