LAUSR

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Tuberculosis can present with myriad manifestations and is a leading cause of morbidity and mortality in the tropical countries. Hepatic tuberculosis is seen in adults and is not so common in children, usually presenting in the fourth to sixth decade of life. The disease shows nonspecific symptoms and is usually incidentally detected. Hepatic tuberculosis can occur in isolation or it can be associated with other findings of systemic tuberculosis like necrotic mesenteric lymph nodes, gastrointestinal tuberculosis or pulmonary tuberculosis. The imaging manifestations of the hepatic tuberculosis can be classified into three main types—parenchymal or military pattern, tuberculous cholangitis and serohepatic variants. The miliary/parenchymal pattern is more commonly seen, whereas the serohepatic variant is rare. Serohepatic pattern of liver involvement presents as multiple focal areas of thickened liver subcapsule leading to the ‘sugar coating’ or ‘frosted liver’ appearance (figure 1). Histopathologically, the connective tissue overlying the liver serosa and Glisson’s capsule are responsible for this appearance. A 53yearold gentle man presented with complains of vague abdominal pain since the last 5 months. Abdominal examination revealed mild tenderness in the right hypochondrium. Routine laboratory investigations revealed elevated alkaline phosphatase 308 u/L, conjugated bilirubin 1.13 mg/ dL and erythrocyte sedimentation rate 45 mm/hour. Ultrasound abdomen revealed multiple nodular hypoechoic lesions in the subcapsular region of the liver (figure 2A,B). Contrast enhanced CT abdomen and pelvis was done for further evaluation. The CT scan was performed on a 64slice Figure 1 Contrast enhanced CT of the abdomen in portovenous phase, axial image (A) shows ‘frosted liver appearance’ with multiple nodular hypodense subcapsular liver lesions (arrow in A); (B) schematic representation of frosted leaf resembling the ‘frosted liver’ (arrow in B).