Amoebic hepatic abscesses (CEUS)

Case contributed by Dr Teresa Fontanilla

Presentation

A recent trip to Thailand. He presents with fever, malaise and right upper hemiabdomen pain.

Patient Data

Age: 40 years
Gender: Male
Ultrasound

Grey scale ultrasound demonstrates 2 round heterogenous hypoechoic lesions. Contrast-enhanced ultrasound demonstrates a smooth wall of lesion which enhances during the arterial phase (17 seconds) with washout at 2 minutes.
These features are consistent with amebic abscesses.

The diagnosis was later confirmed by laboratory findings and by the disappearance of the lesions after specific medical treatment.

Case Discussion

Findings in contrast-enhanced ultrasound of liver abscesses depend mainly on the degree of liquefaction and of the size and shape of the liquefied areas. Liquefied areas don´t enhance at all, whereas walls, septa or phlegmonous areas typically enhance during the arterial phase more intensely than the surrounding liver, and washout during portal or late phases.

Amoebic abscesses are usually rounded, with a homogeneous content in greyscale images and a smooth wall.

Pyogenic abscesses may be round too, but oftentimes they have a geographic shape. Greyscale findings range from very typical findings with fluid content with bubbles to non-specific findings such as hypoechoic heterogeneous focal liver lesions. Contrast-enhanced ultrasound allows depicting the internal structure of the abscess and the size of the liquefied area. this information is important since abscesses with multiple septa or small liquefied areas and predominant phlegmonous components are not suitable for drainage.

Candida abscesses are multiple small round hypoechoic lesions, non-enhancing on contrast-enhanced ultrasound. Usually, spleen lesions are present too.

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