Hepatic candidiasis (CEUS)
Middle age woman with lymphoma and with fever unresponsive to antibiotic treatment. History of splenectomy and currently under chemotherapy treatment.
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Convex probe greyscale ultrasound shows heterogeneous liver parenchyma with small hypoechoic areas. It is difficult to tell if these are lesions or not. Linear higher frequency probe helps to identify a few focal hypoechoic lesions (one is shown). Contrast-enhanced ultrasound depicts many small non-enhancing round lesions, suggestive of abscesses.
The finding of multiple small hepatic abscesses in an immunocompromised patient with infective signs and symptoms suggested strongly the diagnosis of candidiasis.
The differential diagnoses for this case include metastases and lymphoma, because in both cases lesions may be seen as scarcely enhancing lesions in contrast-enhanced ultrasound. However, in both cases, some enhancement is usually seen during the arterial phase, either as a peripheral enhancement with scarce central enhancement in the case of metastases or as poor but present enhancement both in metastases and lymphoma. In both cases washout is very quick and the lesions appear as very hypoenhancing during portal and late phases.