An asymptomatic patient has elevated liver function tests. What is the most likely sonographic finding?

In cases where an asymptomatic patient presents with elevated liver function tests, fatty infiltration of the liver is a common finding on ultrasound. Fatty liver, or hepatic steatosis, often occurs in individuals who may not exhibit any symptoms but have risk factors such as obesity, diabetes, or high alcohol consumption. Sonographically, the liver may appear echogenic or brighter than normal due to the accumulation of fat within liver cells. This increased echogenicity is a hallmark of fatty infiltration that can help in diagnosing the condition without the immediate presence of other signs or symptoms.

Hepatitis typically manifests with additional clinical signs or symptoms, such as jaundice or elevated liver enzymes beyond what would be expected from isolated liver function tests, making it less likely in an asymptomatic patient. Similarly, cirrhosis generally presents with specific complications or clinical indications that arise from chronic liver disease progression. Metastatic disease often has more distinct clinical presentations, such as weight loss or other systemic symptoms, and the ultrasound findings would likely show focal lesions rather than a general echogenicity of the liver tissue. Thus, in an asymptomatic individual with elevated liver function tests, fatty infiltration is the most plausible ultrasound finding.