We describe the imaging findings of the HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome in a gravid 36-year-old-woman who presented at 19.5 weeks gestation with severe right upper quadrant pain. Ultrasound findings suggested a focal hyperechoic liver lesion suggesting pregnancy-related hepatopathy prior to development of biochemical signs of HELLP syndrome. Within 3 days, the patient developed characteristic clinical and laboratory evidence of the HELLP syndrome. MR imaging at this time demonstrated localized hepatic ischaemia, further strengthening the diagnosis of HELLP syndrome.