Hepatic candidiasis on contrast-enhanced ultrasound

Case contributed by Dr Teresa Fontanilla

Presentation

Middle age woman with lymphoma and with fever unresponsive to antibiotic treatment. History of splenectomy and currently under chemotherapy treatment.

Patient Data

Age: Middle age
Modality: Ultrasound

Convex probe grey scale 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.

Case Discussion

The finding of multiple small hepatic abscesses in a 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 hypoechoic during portal and late phases.

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Case Information

rID: 30939
Case created: 10th Sep 2014
Last edited: 9th Jan 2016
Inclusion in quiz mode: Included

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