Multifocal hepatic steatosis (MHS) is a rare subtype of hepatic steatosis which can pose a diagnostic challenge due to difficulty in distinguishing it from malignant disease. Steatotic nodules in MHS can vary in size from a few millimeters to several centimeters and may mimic hepatocellular carcinoma or metastases by both ultrasound and computed tomography assessment. Accurate detection of this abnormality is important and may prevent unnecessary investigation and biopsy, as well as anxiety for the patient. Here we present two cases of MHS occurring in adult siblings. The characteristic radiographic appearances of MHS will be described as well as tips provided for accurate detection. Given the rarity of this entity, the occurrence in two otherwise well adult siblings also raises the possibility of an inherited pathogenesis.