Amoebic hepatic abscesses - contrast enhanced ultrasound
42 year old male with recent trip to Thailand. He presents with fever, malaise and right upper hemiabdomen pain.
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Grey scale ultrasound shows two focal non-specific hypoechoic liver lesions. Other lesion was present (not shown). Contrast enhanced ultrasound allows to diagnose abscesses, owing to the wall enhancement in arterial phase with washout in the late phase, and lack of central enhancement. Considering the roundness and homogeneous appearance in grey scale and the smoothness of the wall in contrast enhanced ultrasound, these lesions are very suggestive of amebic abscesses. Diagnosis was confirmed by laboratory findings and by dissapearance of the lesions after specific medical treatment.
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 an homogeneous content in grey scale images and a smooth wall.
Pyogenic abscesses may be round too, but oftentimes they have a geographic shape. Grey scale 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 to depict 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 area and predominant phlegmonous component 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.
- 1- D'Onofrio M, Crosara S, De Robertis R et-al. Contrast-Enhanced Ultrasound of Focal Liver Lesions. AJR Am J Roentgenol. 2015;205 (1): W56-66. doi:10.2214/AJR.14.14203 - Pubmed citation
- 2- Kishina M, Koda M, Tokunaga S et-al. Usefulness of contrast-enhanced ultrasound with Sonazoid for evaluating liver abscess in comparison with conventional B-mode ultrasound. Hepatol. Res. 2015;45 (3): 337-42. doi:10.1111/hepr.12347 - Pubmed citation