Parenteral Nutrition-Induced Diffuse Nodular Hepatic Steatosis After Hepatocellular Carcinoma Resection: A Case Report

Abstract

Introduction: Hepatic multifocal nodular fatty infiltration induced by parenteral nutrition is a rare complication, particularly in patients with a history of hepatocellular carcinoma who have undergone hepatectomy. Its imaging features may overlap with those of tumor recurrence, leading to misdiagnosis. Clinical data on hepatic multifocal nodular fatty infiltration in patients receiving long-term parenteral nutrition after hepatocellular carcinoma resection remain limited. Case Presentation: We retrospectively analyzed the case of a 50-year-old woman with a 16-year history of hepatitis B virus infection who underwent laparoscopic left hepatectomy for hepatocellular carcinoma in April 2024. The patient received parenteral nutrition with C6 - 24 mixed fat emulsion for more than 1 month postoperatively. Clinical data, laboratory results, and computed tomography and magnetic resonance imaging findings were collected and analyzed, followed by observation of lesion changes after parenteral nutrition withdrawal. On postoperative day 25, imaging revealed multiple well-defined nodular hypodense hepatic lesions. Magnetic resonance imaging showed slightly increased signal intensity on T1- and T2-weighted images, signal reduction on fat-suppression sequences and opposed-phase imaging, and no enhancement on dynamic contrast-enhanced imaging. Liver function indices increased transiently. After parenteral nutrition was discontinued and nutritional support was adjusted for 40 days, partial regression of the lesions was observed. Conclusions: Long-term parenteral nutrition with an excessive lipid emulsion, particularly a lipid energy supply of more than 50%, may induce hepatic multifocal nodular fatty infiltration in patients with metabolic disorders after hepatocellular carcinoma resection. Characteristic imaging features, including the absence of enhancement and fat-signal characteristics, can help distinguish this condition from tumor recurrence. Timely withdrawal of parenteral nutrition and nutritional adjustment may promote lesion regression.