Hospital: HOSPITAL CLÍNICO UNIVERSITARIO DE VALENCIA,
Aut@r o Autores: M. De La Cruz Monferrer, C. Parrilla Muñoz, H. Chicote Huete, S. Busó Gil, M. Aparisi Pons, C. Biosca Calabuig.
Chinese 51-years-old woman with diffuse abdominal pain, malaise, dark urine and vomiting. At the contrast-enhanced abdominopelvic CT, there is a big hypoattenuated multiloculated cystic mass in the left hepatic lobe with peripheral enhancement and internal septations, imaging features of a hepatic abscess, and elevation of left hemidiaphragm. At MR there is a heterogeneous lesion with high signal intensity on diffusion-weighted images, left pleural effusion and small subphrenic collection. Abscess culture is positive for Klebsiella pneumoniae
At US, liver abscesses are seen as round lesions, with variable echogenicity and can have internal septations and gas. On CT images they appear as hypoattenuated lesions, and can be uni/multioculated, a solid or cystic mass,and can have internal septations, gas bubbles or air-fluid levels. They have peripheral and septations enhancement. A transient early wedge-shaped or circumferencial region of hepatic hyperenhancement have been reported. Pleural effusion, atelectasis can be associated. “Cluster sign” and “double target sign” are characteristic imaging features. Liver abscesses caused by K. Pneumoniae have a single, solid-appearing, multiloculated, unilobar, the most of characteristics are similiar to this case. At MR imaging, they have central low T1-weighted and hight T2-weighted signal intensity. The double target sign is seen at T2-weighted images by an iso- to hypointense inner layer and a hyperintense outer layer, the enhancement with contrast is similar to CT. High signal intensity on diffusion-weighted images and hypointensity on ADC maps is usually seen. The differential diagnosis is with tumors, metastases, liver cysts, hematoma, biloma.
Liver abscesses have variety of symptoms and image findings, we should think about them and make a prompt diagnosis and management. Ultrasounds, CT and MR are useful tools for diagnosis and treatment with drainage guided by them.
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