Presentation
History of acute severe epigastric pain 3 weeks ago. The abdominal ultrasound at that time was normal. Progressively the patient developed a right upper quadrant pain with fever, anorexia, malaise, and leukocytosis. MRI requested to rule-out intra-abdominal sepsis.
Patient Data
Age: 50 years
Gender: Male
From the case:
Perforated gastric ulcer with hepatic abscess
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The MRI sequences demonstrate:
- an ill-defined left hepatic lobe mass, composed of numerous lesions of various size and shape, of low signal on T1, heterogeneous high signal on T2 with a peripheral thin rim of enhancement and perilesional edema of high T2.
- a focal defect of the gastric wall is noted at the anterior wall of the antrum with a small intramural abscess 20 x 13 x 10 mm (well-visualized on postcontrast sequences), in continuity with another small collection of interhepatogastric location
- a small simple hepatic cyst is noted in segment 4 as well as a small hemangioma of the segment 3
- enlarged periportal lymph nodes are noted
From the case:
Perforated gastric ulcer with hepatic abscess
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Annotated images;
- red arrow: probable location of the focal gastric wall defect
- yellow arrow: abscess of the gastric wall
Case Discussion
MRI features of a perforated gastric wall with an intramural abscess in continuity with a small interhepatogastric collection with a large abscess formation of the left hepatic lobe; which was confirmed at surgery as a perforated gastric ulcer.
Additional contributor: ZE. Boudiaf, MD, CHU, Constantine Algeria
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