Pyogenic Liver Abscesses Caused by<i>Klebsiella pneumoniae</i>: US Appearance and Aspiration Findings

Hui, Joyce Y. H.; Yang, Michael K. W.; Cho, Danny H. Y.; Li, Allen; Loke, Tkl; Chan, John; Woo, Patrick C. Y.

doi:10.1148/radiol.2423051344

Cited by 74 publications

(62 citation statements)

References 27 publications

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“…Patients with MPLPs had significantly higher incidences of Klebsiella pneumoniae infection and cryptogenic source of infection. These findings are in line with prior reports that Klebsiella pneumoniaeassociated PLA is often cryptogenic and commonly presents as a single large abscess with predominantly multilocular content [17,18]. One of the reasons that Klebsiella pneumoniae infection is often associated with MPLP is speculated as follows.…”

Section: Discussionsupporting

confidence: 91%

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Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Morii¹,

Yamamoto²,

Nakamura³

et al. 2017

GHOA

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Background: Percutaneous catheter drainage (PCD) is currently the preferred therapeutic procedure of pyogenic liver abscesses (PLAs). However, multilocular poorly liquefied PLAs (MPLPs) are unsuitable for PCD. As reports on MPLPs are scarce, we aimed to explore possible therapeutic strategies for this serious type of PLA. Methods:The medical records of patients with PLA who were hospitalized at our institution between January 2011 to December 2015 were retrospectively reviewed. Demographic factors, biochemical, bacteriological, and imaging results, and treatment outcomes were evaluated.Results: Fourteen patients with MPLPs and 37 with drainable PLAs were identified and included in the study. Clinical characteristics were generally similar between the two groups. Klebsiella pneumoniae accounted for the majority of the culprit pathogens in MPLPs. Patients with MPLPs were managed medically without PCD. Despite this, treatment outcomes were not inferior compared to patients with drainable PLAs. Contrast-enhanced images revealed that the intricate septa of the MPLP maintained its blood perfusion. Most MPLPs did not liquefy over the treatment period. Conclusion:We should remember that MPLP is not rare. The septa may have delivered antibiotics adequately into the MPLPs, thus producing good treatment outcomes. Despite our findings, a high level of suspicion of treatment failure is crucial in these patients to ensure favorable treatment outcomes.

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Section: Discussionsupporting

confidence: 91%

“…Indeed, we have experienced a case of huge MPLP with an intraperitoneal rupture who required surgical treatment [16]. This MPLP was caused by Klebsiella pneumoniae infection, which is reported to be often associated with multilocular PLA [17,18].…”

Section: Introductionmentioning

confidence: 99%

Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Morii¹,

Yamamoto²,

Nakamura³

et al. 2017

GHOA

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“…Distinctive US and CT features have been reported in Klebsiella pneumoniae PLA [7,8]. A predominantly solid US appearance of the lesion with irregular margins was observed in Klebsiella-associated liver abscesses, possibly due to their failure of liquefaction [7].…”

Section: Resultsmentioning

confidence: 95%

“…A predominantly solid US appearance of the lesion with irregular margins was observed in Klebsiella-associated liver abscesses, possibly due to their failure of liquefaction [7]. As compared with other bacterial abscesses, a smaller quantity of pus obtained at initial aspiration was reported in Klebsiella PLA [7], which can be related to their predominant solid consistency made up of aggregation of multiple locules that do not communicate. These features were observed in our patients, particularly in the second one where a liver neoplasm was considered in the differential diagnosis.…”

Section: Resultsmentioning

confidence: 97%

Liver abscess caused by Klebsiella pneumoniae: two case reports

et al. 2009

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“…The US appearance varies, usually as a hypoechoic mass with irregular thick walls, internal septa and sometimes gas inside [29]. Clinical information is certainly important.…”

Section: Livermentioning

confidence: 99%

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

et al. 2017

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Contrast-enhanced ultrasound (CEUS) allows a real-time assessment of the vascular pattern of different types of lesions, as it has no renal or liver toxicity, it lacks radiation exposure and it is also cheaper than other imaging methods, having a diagnostic capability that matches contrast-enhanced CT or MRI. In Romania CEUS is used more and more, especially by clinicians, and since some centres have extensive experience in this domain, we felt the need to disseminate our expertise in order to implement this method in as many centres as possible. These Guidelines present the clinical applications of CEUS in the liver, spleen, pancreas, kidney, testis, bowel, intra-cavitary and endoscopic ultrasound, as well as other applications.

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Pyogenic Liver Abscesses Caused byKlebsiella pneumoniae: US Appearance and Aspiration Findings

Abstract: A predominantly solid appearance at US is associated with K pneumoniae monomicrobial liver abscess. K pneumoniae liver abscess is associated with a much smaller quantity of pus at initial aspiration.

Cited by 74 publications

References 27 publications

Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Liver abscess caused by Klebsiella pneumoniae: two case reports

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

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