Presentation
Abdominal pain.
Patient Data
Left hepatic lobe multiple confluent multiloculated cystic lesions showing thick enhancing margins surrounded by hypodense parenchymal edema giving the target sign, associated with mild dilatation of the left intrahepatic biliary radicles, suggestive of hepatic abscesses.
Right lower lobar small cavitary nodule.
The left hepatic cystic lesions elicit high T2 signal and diffusion restriction.
Case Discussion
The case shows typical radiological features of hepatic abscess. The diagnosis was confirmed by ultrasound aspiration of the hepatic cysts which revealed frank pus.
The case illustrates multiple hepatic abscesses with right lower lobar small cavitary nodule, suggestive of disseminated sepsis.
Hepatic abscesses may be caused by:
- ascending cholangitis,
- hematogenous dissemination from a gastrointestinal infection via the portal vein
- disseminated sepsis via the hepatic artery, or contiguous spread.
- direct inoculation, from either penetrating trauma or an invasive procedure (TACE or RF)
Imaging of hepatic abscess
- on US, it might mimic neoplasm
- on CT, it appears of low attenuation with enhancing margins, the enhancing margins may be surrounded by hypodense parenchymal edema giving the target sign
- on MRI, similar to CT with diffusion restriction