Acute alcoholic hepatitis. [Hepatobiliary] [CT]

50 year old female with history of alcohol abuse.

Baseline (6 months before): CT shows diffuse moderately low attenuation liver compatible with (alcoholic) fatty liver disease.

Patient was admitted for septic shock. CT shows a markedly enlarged liver (compare the left margin of the liver [red arrows]), markedly decreased liver attenuation, and engorged portal veins.

Subsequent CTs show the diffusely low liver evolving into a heterogeneous, splotchy, appearance and development of edema [green arrows] from decompensated liver failure. Her total bilirubin rose from baseline 0.4 to 16.4 at the 2 week mark.