Refractory Primary Hepatic Actinomycosis with Direct Infiltration to the Diaphragm and Thorax: The Usefulness of Contrast-enhanced Ultrasonography

Oe, Shinji; Shibata, Michihiko; Hiura, Masaaki; Mitsuoka, Hiroshi; Matsuhashi, Toru; Narita, Ryoichi; Abe, Shintaro; Tabaru, Akinari; Hayashida, Kazuhiro; Taniguchi, Hatsumi; Harada, Masaru

doi:10.2169/internalmedicine.53.2261

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Most patients (94.9%) were immunocompetent. Only 8 patients had underlying immunosuppressive conditions, including hemodialysis (n = 2) [21,63], on corticosteroids (n = 4) [17,[64][65][66], or other immunosuppressive drugs (n = 2) (tacrolimus, hydroxychloroquine) [3,40]. The infection was cryptogenic and considered as primary in 80.8% of the patients, while in 19 (12.2%), 10 (6.4%), and 1 (0.6%) was secondary to pelvic, abdominal, and pulmonary actinomycosis, respectively.…”

Section: Review Of the Literaturementioning

confidence: 99%

A 60-Year Literature Review on Hepatic Actinomycosis

et al. 2022

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Hepatic actinomycosis (HA) is a rare infection with indolent course, atypical clinical manifestations, nonspecific laboratory and imaging findings and challenging diagnosis. We describe a case of a 35-y-old female who developed HA 2 weeks after gastrectomy. In addition, we analyzed clinical characteristics and outcome of 157 additional cases of HA identified in a 60 years’ literature review. Patients with HA were predominantly male (57%) and more than one-half were between 40 and 70 years of age. Of interest, the infection was cryptogenic in 80.8% of cases. Risk factors for HA were identified in 63.1% of the patients. Clinical presentation included fever (57.7 %), abdominal pain (52.1%), weight loss (45.1%), anorexia (27.5%), fatigue and chills (12.7% each), and malaise (12%) over a 2.35±3.5 months period. Leucocytosis, elevated alkaline phosphatase, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the most frequent laboratory findings. Radiologic imaging revealed that the right lobe was more frequently affected (62.5%) with a single lesion found in two-thirds of cases. Diagnosis was achieved by histopathologic examination in 70.6% of cases. Cultures yielded Actinomyces in 45 instances, with A. israelii being the most frequent species. Less than one half of the patients were treated only with antibiotics, while the others received combined medical and surgical treatment. The median duration of antibiotic therapy was 135 days (range: 7-730 days). The presence of multiple lesions or solid tumor like lesions was significantly associated with medical therapy alone. The outcome was favorable in most cases (94%). Although rarely encountered, HA should be considered in patients with a chronic or subacute inflammatory process of the liver, in order to promptly diagnose and treat.

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Section: Review Of the Literaturementioning

confidence: 99%

A 60-Year Literature Review on Hepatic Actinomycosis

et al. 2022

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“…PHA occurs worldwide, but only 87 cases were reported in English literature between 1966 and 2015; none of them were from mainland China. This case prompted us to review PHA cases reported from mainland China in Chinese literature, and share the experience with the colleagues in the rest of the world.…”

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confidence: 99%

Primary hepatic actinomycosis mimicking liver tumour

Zeng

Zheng

Qunji

et al. 2016

ANZ Journal of Surgery

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A 38-year-old man was admitted to our hospital with a major complaint of 15-day abdominal pain in the upper right quadrant and intermittent fever of 38 C. Physical examination revealed tenderness in the upper right quadrant. Laboratory tests including white blood cell count, alanine aminotransferase, bilirubin and alpha fetoprotein were all normal. Computed tomography (CT) revealed an approximately 6 × 6 cm 2 hypodense mass in the left lateral segment of the liver. Enhanced CT scan of the mass demonstrated continued enhancement, that is, relatively low density in the artery phase and relatively high density in the equilibrium phase ( Fig. 1). The surface of the left lobe was blurred, leading to suspicion of a tumour infiltrating into the surrounding tissue. The above findings were highly suggestive of hepatic malignant tumour and thus surgical resection was scheduled. Intraoperatively, a firm mass of 6 cm in diameter at the base of segments II and III was found, which adhered to the anterior abdominal wall and diaphragm. There were yellowish nodules and necrotic tissue inside the mass. The left lobectomy of the liver was then performed. Macroscopically, the resected liver showed a yellowish-white mass that contained frequent pus-like areas. Histological examination revealed an abscess containing multiple aggregates of acute and chronic inflammatory infiltrates with florid fibrosis. Notably, several clusters of filamentous microorganisms consistent with actinomyces colonies (socalled sulphur granules) were present (Fig. 2). Filamentous bacteria were detected in the sulphur granules and positive for Gram staining. The overall features were those of primary hepatic actinomycosis (PHA). Thus, the diagnosis was confirmed to be PHA. The patient received intravenous cefoperazone for 7 days after the surgery and fully recovered and discharged. He was followed-up for 2 years and remained uneventful.PHA occurs worldwide, but only 87 cases were reported in English literature between 1966 and 2015; 1-6 none of them were from mainland China. This case prompted us to review PHA cases reported from mainland China in Chinese literature, and share the © 2016 Royal Australasian College of Surgeons ANZ J Surg 88 (2018) E629-E630

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The role of CEUS in diagnosing tuberculous abscess of the right diaphragm

Zhang,

Yu,

et al. 2024

BMC Infect Dis

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Purpose To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in detecting tuberculous diaphragmatic abscess (TDA) of the right diaphragm and provide a reference for its clinical diagnosis. Methods A retrospective analysis was conducted on 33 patients with right TDA confirmed via surgery and biopsy. The diagnostic accuracy of CEUS and routine ultrasound for detecting right TDA was compared. Results Among the 33 right TDA cases, the lesions primarily exhibited mixed and low echogenicity, with an orientation parallel to the diaphragmatic surface. Eighteen patients (54.5%) demonstrated the characteristic “crocodile mouth sign.” Heterogeneous enhancement was observed in most cases (24 patients) compared to homogeneous or no enhancement. The diagnostic accuracy of routine ultrasound for right TDA was 54.50% (18/33), whereas CEUS demonstrated a significantly higher accuracy of 78.78% (26/33) (χ 2 = 4.364, P = 0.037). Conclusion CEUS provides valuable insights into the vascular characteristics of right TDA, with most cases showing mixed echogenicity and heterogeneous enhancement. The “crocodile mouth sign” was a distinctive feature, highlighting the utility of CEUS in improving diagnostic accuracy for right TDA.

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Refractory Primary Hepatic Actinomycosis with Direct Infiltration to the Diaphragm and Thorax: The Usefulness of Contrast-enhanced Ultrasonography

Cited by 4 publications

References 24 publications

A 60-Year Literature Review on Hepatic Actinomycosis

A 60-Year Literature Review on Hepatic Actinomycosis

Primary hepatic actinomycosis mimicking liver tumour

The role of CEUS in diagnosing tuberculous abscess of the right diaphragm

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