- Clinical: Typically adults on long-term amiodarone therapy for arrhythmias; may have elevated liver enzymes; often asymptomatic but can have hepatotoxicity risk factors like duration and dosage of amiodarone
- Etiology/Pathophys: Iodine-rich amiodarone and its metabolite desethylamiodarone accumulate in hepatocytes causing increased liver iodine content; leads to increased CT attenuation and possible toxic injury (e.g., steatohepatitis)
- Radiograph: Not applicable for hyperdense liver detection; main modality is CT
- CT: Markedly increased liver parenchymal attenuation (hyperdense liver), often >90-150 HU on non-contrast scans; liver density significantly exceeds spleen density (normal liver/spleen ratio ~1-1.3); hyperattenuation due to iodine content, seen without IV contrast
- DDx: Primary hemochromatosis (iron overload with MRI paramagnetic effects), Wilson disease (copper), glycogen storage disease type IV, gold deposition; differentiation by clinical context, lab tests, and absence of iron deposition imaging features
- Tx: Discontinuation or dose reduction of amiodarone if hepatotoxicity present; monitoring liver enzymes and imaging; no treatment if only asymptomatic iodine deposition without toxicity
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