Sonographic detection of multipleStaphylococcus aureus hepatic microabscesses mimickingCandida abscesses

Abstract

We report the sonographic, CT, and clinical findings in a patient presenting with clinical sepsis and multiple Staphylococcus aureus hepatic microabscesses. Although contrast‐enhanced CT has had a higher sensitivity than sonography in detecting hepatic microabscesses in some studies, this examination was negative in our patient. On sonography, numerous small hypoechoic lesions were present. Some target‐like lesions had a striking similarity to Candida albicans microabscesses. The hepatic lesions were believed to be pyogenic liver microabscesses, as several blood cultures were positive for S. aureus. Following prolonged intravenous antibiotic therapy, all the hypoechoic hepatic lesions disappeared, along with the clinical and biochemical signs of sepsis. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:478–481, 1999.

Molecular mechanisms of NET formation and degradation revealed by intravital imaging in the liver vasculature

“…2a ). The appearance of the necrotic loci upon MRSA treatment was observed in various strains of mice (C57Bl/6, Balb/c and B6.129) and has previously been reported in pigs and in humans 31 32 . Large liver abscesses are rare in humans 33 and were not seen in our mouse model.…”

“…In humans, MRSA-induced liver abscesses are also not commonly described 33 , perhaps due to the profound and rapid healing power of the liver. However, some liver necrosis is not unusual, and in humans if microabscesses develop they are potentially life-threatening 31 42 , and multiple liver abscesses lead to higher mortality than single abscesses 33 . The elevated liver enzyme levels, and even the observed liver lesions in our model, only lasted 24–72 h and would likely have been missed in humans who are often infected for prolonged time points before entering intensive care units.…”

Sonographic “Bull's Eye” Pattern of Multiple Liver Lesions: Atypical Presentation of Pyogenic Abscesses

“…Although these target-like lesions almost always are metastases or mycotic abscesses (usually caused by Candida albicans, being considered a classic finding for this diagnosis) [1,2,3], conditions such as localized lymphomatosis, hepatocellular carcinoma, and pseudotumors in segment IV also present with this finding [2]. The bull's eye sonographic appearance of multifocal lesions proved to be multiple pyogenic liver abscesses (PLAs) is an atypical finding [3] that has received little attention in the literature. These lesions may be misdiagnosed FIG.…”

“…[5,6], with an additional role in revealing an underlying etiology [6] and in guiding percutaneous aspiration and drainage. Ultrasonography can be diagnostic in more than 90% of cases [7], detecting even millimeter-size lesions [3]. The sonographic features of PLAs may be quite variable in shape, size, and echogenicity, ranging from anechoic to hyperechoic [7,9].…”

“…The sonographic features of PLAs may be quite variable in shape, size, and echogenicity, ranging from anechoic to hyperechoic [7,9]. Multiple PLAs have been described rarely in the literature [8]; interestingly, the sonographic presentation of multiple PLAs with some lesions having a bull's eye appearance is even rarer [3]. The echogenic core of bull's eye lesions in the setting of Candida abscesses is associated with the presence of inflammatory cells [9]; in metastatic lesions, this appearance histologically represents a central area of coagulative necrosis encircled by a zonal area of viable tumor [1]; in pseudotumors, the lesions are believed to represent a spared peripheric area with a steatotic central zone [2].…”