A 34-year-old male with f...

A 34-year-old male patient visited the Clinic for Diagnostics and Management following a previous evaluation to determine the next steps in his treatment. Physical examination revealed no abnormalities, with vital signs within normal ranges. The patient had no history of alcohol consumption, diabetes, drug therapy, or viral hepatitis C. A chest CT conducted at another clinic showed no lung parenchymal abnormalities but revealed heterogeneous liver parenchyma with multiple hypodense nodular foci as shown in figure 01. These nodules had variable sizes, up to 2.5 cm in diameter, and were found in the liver. The density of these lesions was approximately +30 Hounsfield Units (HU), with the background liver parenchyma density measuring +50 HU. No mass effect or disruption of vascular structures was observed. Laboratory analysis, including liver function and tumour markers, did not indicate abnormalities. Elastography suggested moderate fibrosis (stage F2), and contrast-enhanced MRI confirmed the presence of hepatic lesions indicative of moderate fatty hepatosis (grade 2). A preliminary diagnosis of non-alcoholic fatty liver disease (NAFLD) was established, leading to a percutaneous liver biopsy, which revealed third-degree macrovesicular steatosis and second-degree steatohepatitis with first-stage fibrosis. Consequently, based on histopathological analysis, the clinical diagnosis was non-alcoholic fatty liver disease: steatohepatitis (second degree) and liver fibrosis (first stage).1