is believed that the presence of focal hypoechoeic areas(FHa) within the liver hilum (and elsewhere in the liver )corresponds to parenchymal islands with(close to) normal fat content (due to a locally different blood supply), that are surrounded and contrasted by bright echogenic parenchyma with fatty infiltration. Subcapsular FhA and FHa close to liver veins are other typical locations, the shape of these pseudolesions" being polycyclic and non-round. FHA are relatively specific for hepatic steatosis and may be helpful to differentiate fatty from fibrotic liver disease Similar focal hypoechoeic areas were demonstrated in patients with liver steatosis due to systemic corticosteroid therapy, even though the more important focal lesions in this condition are hyperechoic [Figure 8]. Pathophysiologically areas of different fat content might be explained by a different arterial and portal venous blood supply in comparison to the surrounding liver parenchyma which is mainly portal venous and contains, therefore, a higher fat and insulin concentration in focal fatty infiltration [(32;38) Figure 7 Hepatic steatosis. Perhaps the most objective and therefore most important sign of hepatic steatosis are circumscribed focal hypoechoic areas in the liver hilum examined in a left posterior oblique position. B-mode ultrasound demonstrates a focal liver lesion in between calipers(a). Colour Doppler imaging indicates a centrally located vessel of undetermined origin(b) a Figure 8 Hepatic steatosis indicated by focal hyperechoic ([(28)) areas in the liver hilum They are characterised by centrally located(portal) vein branches identified by colour Doppler imaging(a), spectral analysis and CEUS (b). Such lesions also typically found subcapsular next to the teres ligament [(28)1 Distanz=3.20cmis believed that the presence of focal hypoechoeic areas (FHA) within the liver hilum (and elsewhere in the liver) corresponds to parenchymal islands with (close to) normal fat content (due to a locally different blood supply), that are surrounded and contrasted by bright echogenic parenchyma with fatty infiltration. Subcapsular FHA and FHA close to liver veins are other typical locations, the shape of these “pseudolesions” being polycyclic and non-round. FHA are relatively specific for hepatic steatosis and may be helpful to differentiate fatty from fibrotic liver disease. Similar focal hypoechoeic areas were demonstrated in patients with liver steatosis due to systemic corticosteroid therapy, even though the more important focal lesions in this condition are hyperechoic [Figure 8]. Pathophysiologically areas of different fat content might be explained by a different arterial and portal venous blood supply in comparison to the surrounding liver parenchyma which is mainly portal venous and contains, therefore, a higher fat and insulin concentration in focal fatty infiltration [(32;38)]. Figure 7 Hepatic steatosis. Perhaps the most objective and therefore most important sign of hepatic steatosis are circumscribed focal hypoechoic areas in the liver hilum examined in a left posterior oblique position. B-mode ultrasound demonstrates a focal liver lesion in between calipers (a). Colour Doppler imaging indicates a centrally located vessel of undetermined origin (b). a b Figure 8 Hepatic steatosis indicated by focal hyperechoic ([(28)] areas in the liver hilum. They are characterised by centrally located (portal) vein branches identified by colour Doppler imaging (a), spectral analysis and CEUS (b). Such lesions are also typically found subcapsular next to the teres ligament [(28)]. a b