Fatty change of the liver is a well-recognized entity associated with many clinical situations. It is a diffuse lesion although it may show centrolobular or periportal accentuation. Focal fatty change, on the other hand, is a rarely recognized and poorly characterized entity. We are presenting 10 cases of this condition. The lesions were discovered incidentally at post mortem examination in patients ranging in ages from 26 mo to 79 yr. The nodules measured up to 4.0 cm in diameter, were predominantly subcapsular in location, and the majority occurred in livers with minimal diffuse steatosis. At autopsy some had been confused with abscesses and metastases. The underlying disease processes and therapy were examined to determine etiology. Focal ischemia superimposed upon conditions producing fatty change is postulated as a pathogenic mechanism for this entity. Focal fatty change may have importance in the differential diagnosis of space-occupying lesions of the liver.