case_images: PMC10905307_01
case_images: Ultrasound of the abdomen and pelvis and magnetic resonance cholangiopancreatography (MRCP) of the reported patient. Figure 1A: An ultrasound of the abdomen and pelvis reveals an enlarged liver measuring 18 cm and homogeneous parenchyma with no focal lesions or intrahepatic biliary dilatation. The portal vein and common bile duct are unremarkable. The gallbladder is surgically removed. The pancreas and both kidneys are unremarkable. The spleen is enlarged, measuring 18 cm, with no focal lesions. There is no ascites. Figure 1B: The MRCP shows two focal areas of cholangitis in the right liver lobe associated with a beaded appearance, suggestive of sclerosing cholangitis with multiple unchanged liver lesions, which represents mostly hepatic abscesses; however, cystic neoplasm could not be totally excluded. There are no radiological signs of pancreatitis.
case_images: cureus-0016-00000053280-i01.jpg
case_images: PMC10905307_01_cureus-0016-00000053280-i01.jpg
case_images: FIG1
case_images: Abdominal ultrasound showed biliary sludge with no intrahepatic or extrahepatic biliary dilation, while magnetic resonance cholangiopancreatography (MRCP) showed an enlarged (21 cm diameter) fatty liver with mild dilatation of the intra- and extrahepatic biliary systems and multiple areas of narrowing and stricture formation with no obvious intrahepatic stone formation (Figure 1).
case_images: Radiological studies of the reported patient. Figures 2A-2C: Lumbar spine x-ray revealing osteopenia with narrowed intra-vertebral spaces (A: lumbar spine lateral x-ray with flexion, B: lumbar spine lateral x-ray with extension, and C: lumbar spine anteroposterior x-ray). Figure 2D: The MRI confirmed a 12th-thoracic vertebral-first-lumbar vertebra (T12-L1) compression fracture with biconcave deformity of their endplates, illustrating the classical codfish radiological sign appearance (yellow arrows).
case_images: cureus-0016-00000053280-i02.jpg
case_images: PMC10905307_01_cureus-0016-00000053280-i02.jpg
case_images: FIG2
case_images: An MRI of the spine confirmed the presence of compression fractures of the 12th-thoracic and first-lumbar vertebrae (T12-L1) and her bone densitometry revealed a Z-score of -6.4 at the lumbar spine and -5 at the femoral neck (Figure 2).