We know that unless mathematical calculations are used, the gross size of the liver seen on liver scan is erroneous and misguiding. Absence of a positive serological test for amoebiasis in high dilution would be in favour of this hepatomegaly being non-amoebic. I have not tried to differentiate 'alcoholic fatty liver' from 'alcoholic hepatitis'. Liver biopsy has not been done, as it is not liked especially by Bahraini population. Soon NMR imaging will be available in Bombay and it would help to pick up a fatty liver without a biopsy.
More problems arise when a cold area is spotted on a liver scan.
Two things should be kept in mind. The isotope imaging report is not the 'last' word. It is not safe to investigate all such patients by liver biopsy. When these are absolutely normal, do not ask for liver biopsy. Once a cold area is detected, sonography is the next investigation to exclude a cyst.