Hepatobiliary/GI Case Report 15














New York University School of Medicine Department of Radiology
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Hepatobiliary/GI Case Report 15
Contributor: Allison Levy, M.D. and Manmeen Kaur, M.D.
Date: July 6, 2004


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Patient History

55 year-old woman with a “cystic” mass in her liver on abdominal ultrasound.

Images

(Download DICOM files)

	Figure 1: Axial T2-weighted image with fat saturation.
	Figure 2: Pre-contrast axial T1-weighted 3D GRE (VIBE) with fat saturation.
	Figure 3: Post-contrast axial T1-weighted 3D GRE (VIBE) with fat saturation.

Findings

Figure 1: Axial T2 demonstrate a large fluid filled structure in the right lobe of the liver. There is a thick irregular border with surrounding edema.

Figure 2: Pre-contrast axial VIBE shows large fluid filled mass in right lobe of liver with thick irregular low intensity border.

Figure 3: Post-contrast axial VIBE shows enhancement of the wall of the mass. Perfusion abnormality surrounding mass represents hyperemia.

Diagnosis

Hepatic abscess.

Discussion

Hepatic abscesses are uncommon in Western countries. There is a slight female predominance, usually affecting individuals between 40 – 60 years of age. Biliary tract disease remains the most common source of pyogenic liver abscess and accounts for 60% of cases. Other causes include portal vein pyleophlebitis, hepatic artery septicemia, direct extension and trauma. E. coli is the most common organism cultured in adults. In children, staphylococci is more common.

At MR imaging, hepatic abscesses demonstrate decreased T1 signal and increased T2 signal. Gadolinium enhanced MR images reveal enhancement of the peripheral rim relative to the necrotic center. CT scan and ultrasound are the radiologic modalities of choice as both screening procedures also can be used as techniques for guiding percutaneous aspiration and drainage. Advances in drainage techniques have decreased mortality rates, however, untreated, this infection remains uniformly fatal.

References:

Gore R, Levine M, I Laufer (eds). Textbook of Gastrointestinal Radiology . Philadelphia : W.B. Saunders, 1994.
Cantisani V, Visconti S, et al (2002). Multiple Pyogenic Hepatic Abscesses: CT And MRI Findings. European Association of Radiology. (7/19/04)


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