Computed tomography of hyper-attenuated liver: Pictorial essay

Demonstration of a very dense or hyper-attenuated liver on the pre-contrast CT images of the abdomen can be an unexpected finding. It may present as a diagnostic challenge if the underlying cause of it is not apparent from the provided clinical history. There are about 12 different pathologic conditions that are associated with deposition of radiopaque elements within the hepatic parenchyma, resulting in diffuse or multi-lobar hyperdense appearance of the liver on abdominal radiographs and CT. Most of them are drug-induced or iatrogenic in nature, while others are the sequelae of genetic disorders like thalassemia, Wilson's disease, and primary hemochromatosis. This pictorial essay will present the CT appearance and etiology of hyper-attenuated liver in various clinical entities. •Hyper-attenuated liver is best diagnosed by non-enhanced CT.•It appears as diffusely increased liver density of over 70 HU.•It indicates deposition of radiopaque elements in the liver parenchyma.•The most common cause of it is iodine from amiodarone therapy.•Various other etiologies of this condition are presented.