Elderly female with frequent falls.

PATIENT PRESENTATION

An 88‐year‐old woman with chronic atrial fibrillation and heart failure presented to the emergency department complaining of frequent falls. On workup, liver aspartate aminotransferase (130 U/L) and alanine aminotransferase (103 U/L) were elevated. A non‐contrast computed tomography (CT) scan of the abdomen was performed.

DIAGNOSIS

Increased radiodensity of the liver associated with amiodarone

The abdominal CT scan showed increased density of the liver with a radiodensity of 135 Hounsfield units (HU) (normal range, 30–70 HU) (Figure 1). This CT finding may be associated with chronic amiodarone use. The increased radiodensity was due to excessive iodine in the liver, secondary to deposition of amiodarone and its major metabolite desethylamiodarone. Although liver radiodensity is associated with the serum level of desethylamiodarone, the relationship between liver radiodensity and amiodarone hepatotoxicity is not clear. Prior cases report the reduction of liver density after discontinuation of amiodarone. Clinicians should consider amiodarone toxicity in the presence of this CT finding.

FIGURE 1

A non‐contrast computed tomography scan of the abdomen showed the bright liver. The radiodensity of the liver was 135 Hounsfield units