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Figure 1. Radiological images demonstrating poor ultrasound image quality due to central obesity, case 1. (A) Longitudinal section ultrasound image of the left lobe in a patient with large body habitus. Significant acoustic shadowing obscures the liver and a focal liver lesion cannot be excluded. The patient had a rise in AFP and so an MRI was arranged and a staging CT of the chest, abdomen and pelvis. (B) MRI demonstrating a 17mm focal lesion in the left lobe which on portal venous phase shows washout. (C) Arterial phase CT image shows a poorly defined low-density lesion with a subtle increased vascularity identified from the staging CT.