Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls

Abstract

Imaging plays an important role in the diagnosis, characterization, and management of infectious liver disease. In clinical practice, the main contributions of imaging are in detecting early disease, excluding other entities with a similar presentation, establishing a definitive diagnosis when classic findings are present, and guiding appropriate antimicrobial, interventional, or surgical treatment. The most common imaging features of bacterial, viral, parasitic, and fungal hepatic infections are described, and key imaging and clinical manifestations are reviewed that may be useful to narrow the differential diagnosis and avoid pitfalls in image interpretation. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging allow accurate detection of most hepatic infections and, in some circumstances, may provide specific signs to identify the underlying pathogen and exclude other entities with similar imaging features. In bacterial and parasitic infections, specific imaging features may be enough to exclude a neoplasm and, occasionally, to identify the underlying infectious agent. US and CT are important means to guide percutaneous aspiration or drainage when needed. In viral infections, imaging is critical to exclude entities that may manifest with similar clinical and laboratory findings. Disseminated fungal infections require early detection at imaging because they can be fatal if not promptly treated. Familiarity with the epidemiology, pathogenesis, clinical manifestations, imaging features, and treatment of hepatic infections can aid in radiologic diagnosis and guide appropriate patient care. (©)RSNA, 2016.

Non-neoplastic hepatopancreatobiliary lesions simulating malignancy: can we differentiate?

“…It is also difficult to differentiate necrotic liver tumors from abscesses. Nodularity in the internal surface of the lesion wall, focal calcifications within the lesion, and the absence of perilesional edema favors necrotic neoplasm over an abscess [24]. Follow-up imaging after empirical treatment for liver abscess may also be year-old female with previously surgically treated pancreatic adenocarcinoma now presenting with a hypoechoic focal liver lesion detected in outside US.…”

“…An enhancing wall and a peripheral edema are also a common feature. Also, septations may be seen within the abscess cavity [24,26].…”

US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease

“…Liver abscess, the most common type of visceral abscess (11), can be categorized as pyogenic or parasitic and cause RUQ pain with positive US findings. Pyogenic abscesses can be caused by bacterial or fungal organisms, and knowledge of the patient's medical history, risk factors, and presentation are helpful in making the correct diagnosis.…”

“…Direct extension of infection can occur from infection of adjacent structures, such as right lower lobe (RLL) pneumonia. Other routes of infection include ascending cholangitis and direct inoculation, such as from penetrating trauma or an invasive procedure (11). Most pyogenic abscesses in North America are polymicrobial, with Escherichia coli and Klebsiella pneumoniae being the most common offending agents in all patients (11).…”

Dolor abdominal: causas poco frecuentes

“…38 El organismo más frecuentemente aislado es el stafilococcus aureus (88% de los casos) seguido por la Escherichia coli y el streptococcus. 39 El riesgo de mortalidad en pacientes no tratados puede llegar al 100%, 40 por lo que es importante hacer un diagnóstico temprano; sin embargo los síntomas son inespecíficos, se ha descripto una triada clásica de fiebre, dolor de espalda y espasmos del psoas en el 30% de los pacientes. 41 La TC con contraste es el método de elección para el diagnóstico.…”