Typical imaging finding of hepatic infections: a pictorial essay

Abstract

Hepatic infections are frequent in clinical practice. Although epidemiological, clinical and laboratory data may suggest hepatic infection in certain cases, imaging is nearly always necessary to confirm the diagnosis, assess disease extension and its complications, evaluate the response to treatment, and sometimes to make differential diagnoses such as malignancies. Ultrasound (US) is usually the first-line investigation, while computed tomography (CT) and magnetic resonance imaging (MRI) provide better characterization and a more precise assessment of local extension, especially biliary and vascular. The purpose of this article is to describe the typical features and main complications of common hepatic infections. Familiarity with the radiological features of this entity can help suggest the correct diagnosis and the need for further studies as well as determine appropriate and timely treatment.

Follow-up Strategies in Focal Liver Lesions and Treatment Methods

“…In cases such as cholangitis, portal phlebitis, pathogens enter through the portal venous system or biliary tract. The possibility of occult colorectal neoplasia should be considered, especially in patients diagnosed with pyogenic liver abscess due to K. pneumoniae and in the absence of apparent underlying hepatobiliary disease [18,19]. Peribiliary abscesses tend to be scattered, small and adjacent to the biliary tree; In appendicitis or diverticulitis, pathogens can cause larger lesions in the liver via the hepatic artery or portal vein (hematogenous).…”

“…Pyogenic abscess is treated with drainage or surgery. In Nepal, in 102 patients with pyogenic liver abscess who did not have abscess drainage, the mean time to ultrasonographic resolution of abscesses <10 cm was 16 weeks, and the mean time to resolution for abscesses > 10 cm was 22 weeks [19]. For patients with persistent clinical symptoms with evidence of persistent abscess following drainage intervention and antibiotic therapy, reassessment for re-drainage is required.…”

Radiological Approach to Diagnosis of Peribiliary Lesions

“…9 On CT, abscesses appear as well-defined, hypodense, round or irregular shaped lesions with peripherally enhancing inner rim and hypoattenuating outer rim ("double target sign")(Figure 2). 9,10 Coalescing multiple small hypodense abscesses give rise to the "cluster sign". 9,10 These are associated with transient, early, wedge shaped adjacent parenchymal enhancement due to inflammation and compression of small portal venules due to mass effect resulting in reduced portal flow and a compensatory increase in hepatic arterial inflow.…”

Abses Hepar : Sebuah Laporan Kasus

“…Temuan radiologi yang paling umum adalah double target sign, baik pada abses hepar piogenik maupun abses hepar amebik, yang ditemukan berdasarkan pemeriksaan CT. Tanda lain yang dapat ditemukan pada abses hepar piogenik adalah cluster sign [7]. Lesi umumnya terdapat pada lobus kanan hepar, namun dapat ditemukan juga lesi pada lobus kiri dan lobus kaudatus [5,8,9].…”