Fatty liver, focal sparing and gallbladder polyp

46 year old man complained of generally unwell and fatigue. His GP did a blood test which showed significantly altered liver function. He was referred for ultrasound.
Ultrasound showed generalised increase in echotexture. This is consistent with fatty liver.
The transverse diameter of the liver is 14cm (normal <15cm).

 Compare the echogenicity of the liver. It is in sharp contrast to that of the renal parenchyma.

Multiple areas of normal liver are seen interspersed within the fatty liver. These are areas of focal sparring.

 The gallbladder showed multiple polyps within it.