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RADIOLOGY: HEPATOBILIARY: Case# 32884: HEPATIC ABSCESS, DIABETIC, FEVER/SEPSIS (MICU). 60-year-old woman with long-standing insulin-dependent diabetes, leukocytosis, fever, and nausea. A large cavity, which mostly contains air, fills a large portion of the lateral segment of the left hepatic lobe. This lesion has irregular borders and contains an irregular air fluid level, though there is very little fluid overall, with small nodules of soft tissue density throughout the lesion which is mostly filled with air. There is no thickened enhancing rim surrounding the lesion. Also in the left hepatic lobe, but slightly more inferior, pneumobilia is noted, but there is no biliary ductal dilatation. The right lobe of the liver is unremarkable. There is a minimal amount of probably atelectasis in both lung bases. There is no free fluid or free air. No adenopathy is identified. The spleen, pancreas, adrenal glands, and kidneys are unremarkable. Pyogenic liver abscesses occur predominantly in individuals with other underlying disorders, most commonly biliary tract disease. Abscesses may also occur following hepatic transplantation. Clinical findings are nonspecific with fever and jaundice being the most common. Diagnosis is best made by contrast-enhanced CT or ultrasound. Pyogenic abscesses are usually solitary and often multiloculated with thickened enhancing walls. Gas is present in about 20% of cases. Amoebic abscesses are also solitary lesions. Pyogenic abscesses may be distinguished from amoebic abscesses on the basis of clinical findings. Whereas patients with pyogenic abscesses are usually septic, patients with amoebic abscesses are not, and they usually have a history of travel to an endemic area. Pyogenic abscesses require drainage while amoebic abscesses do not and may be treated with antibiotics. Hepatic infarcts may also occur following hepatic transplantation. Partial or complete hepatic artery obstruction may present as lobar areas of inhomogeneous low attenuation and may require retransplantation. Occlusion of hepatic arterial branches may produce round or oval central lesions or wedge-shaped peripheral lesions that may contain gas, giving the appearance of an abscess. These infarcts may be seen as poorly demarcated areas that progress to become more confluent and delineated.

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