Ultrasonography and computed tomography of hepatic candidiasis in immunosuppressed patients.

Abstract

The ultrasonic appearance of Candida infection in the livers of immunosuppressed patients is quite characteristic. Cystic, target·like lesions were found in three patients receiving chemotherapy for myeloproliferative diseases. The computed tomographic appearance is less characteristic. A possible explanation for the appearance of these lesions is presented. (Key words: candidiasis, computed tomography, immunosuppression) Distinctive-appearing lesions in the livers of two patients receiving chemotherapy for myeloproliferative disorders have recently been reported. 1Postmortem examination in both cases revealed Candida infection of the liver. We describe three more cases demonstrating similar-appearing lesions and offer a possible explanation for the cause of this appearance. CASE REPORTSCase 1. A 54-year~old man with myelomonocytic leukemia had pain and tenderness in the right upper quadrant when first seen. An ultrasonic examination performed to look for biliary diseuse demonstrated several well-defined, echo-poor lesions in the liver parenchyma (fig. lA}. These measured between 1 and 2 em and had single small, echogenic centers within otherwise cysticappearing lesions. A computed tomographic (CT) scan was also performed to further delineate these lesions, and similar target-like lesions were identified (radiolucent le· sions with radiopaque centers; fig. 1B).The patient subsequently underwent laparotomy. Multiple firm, whitish nodules were noted throughout the liver substance. A biopsy of one of these lesions showed it to consist (on microscopic examination) of necrotic material with a clump of fungal mycelia at the center of the lesion.Case 2. A 30-year-old woman who had been diagnosed as having a T·celllymphoma had received several

Hepatic abscesses in the immunocompromised patient: Role of CT in detection, diagnosis, management, and follow-up

“…In patients with disseminated candidiasis, GI tract involvement is very common, especially in patients with leukemia; and there is a high frequency of hepatic and splenic involvement as well [5]. The role of CT in the detection, diagnosis, and follow-up of hepatic and splenic microabscesses from disseminated fungal infections has been reported previously [6][7][8][9]. As in our patients, these lesions usually appear as multiple, low-attenuation lesions of varying size in the liver and spleen.…”

Ultrasound of focal liver lesions

“…Fungal abscesses usually occur in immunocompromised patients with Candida being the most common organism [58,59]. Multiple or disseminated microabscesses are usual and the use of high-frequency probes aids their detection.…”