EURORAD ESR

Case 14799

A rare case of emphysematous hepatitis with spontaneous pneumoperitoneum

Author(s)
Madalena Ramalho, António Costa, José Fonseca Santos

Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Serviço de Radiologia; Av. Professor Egas Moniz 1649-035 Lisboa, Portugal; Email:madalenaramalho@ymail.com
 
Patient
female, 78 year(s)
 
 
  • Figure 1
    CT
     

    CT axial image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Between the left border of the liver and the stomach there was a small pneumoperitoneum (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT axial image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Between the left border of the liver and the stomach there was a small pneumoperitoneum (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT axial image depicting the communication (blue lines) between the intrahepatic gas (circle) and the pneumoperitoneum (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    CT
     

    CT axial image depicting patent hepatic arteries.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT axial image depicting patent portal veins.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    CT
     

    CT coronal reconstruction image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT coronal reconstruction image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT coronal reconstruction image depicting a small pneumoperitoneum between the left border of the left hepatic lobe and the small gastric curvature (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT coronal reconstruction image depicting a small pneumoperitoneum between the left border of the left hepatic lobe and the small gastric curvature (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    CT
     

    CT sagittal reconstruction image showing an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Pneumoperitoneum between the left border of the liver and the stomach is also seen(arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT sagittal reconstruction image showing an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Pneumoperitoneum between the left border of the liver and the stomach is also seen(arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    CT sagittal reconstruction image showing an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Pneumoperitoneum between the left border of the liver and the stomach is also seen(arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 5
    CT Scout

    CT scout view of the abdomen (antero-posterior projection) depicting an ill defined rounded area of hipodensity (circle) consistent with the CT findings of intrahepatic gas

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 6
    US

    Ultrasound transverse view of the left hepatic lobe showing extensive dirty echogenic shadowing in the left hepatic lobe compatible with intrahepatic gas (circle).

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 7
    CT

    CT axial image after left hepatectomy.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
CT axial image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Between the left border of the liver and the stomach there was a small pneumoperitoneum (arrow).
 
CT axial image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Between the left border of the liver and the stomach there was a small pneumoperitoneum (arrow).
 
CT axial image depicting the communication (blue lines) between the intrahepatic gas (circle) and the pneumoperitoneum (arrow).
 
CT axial image depicting patent hepatic arteries.
 
CT axial image depicting patent portal veins.
 
CT coronal reconstruction image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle).
 
CT coronal reconstruction image depicting an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle).
 
CT coronal reconstruction image depicting a small pneumoperitoneum between the left border of the left hepatic lobe and the small gastric curvature (arrow).
 
CT coronal reconstruction image depicting a small pneumoperitoneum between the left border of the left hepatic lobe and the small gastric curvature (arrow).
 
CT sagittal reconstruction image showing an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Pneumoperitoneum between the left border of the liver and the stomach is also seen(arrow).
 
CT sagittal reconstruction image showing an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Pneumoperitoneum between the left border of the liver and the stomach is also seen(arrow).
 
CT sagittal reconstruction image showing an area of mottled gas opacity replacing the parenchyma of left hepatic lobe (circle). Pneumoperitoneum between the left border of the liver and the stomach is also seen(arrow).
 
CT scout view of the abdomen (antero-posterior projection) depicting an ill defined rounded area of hipodensity (circle) consistent with the CT findings of intrahepatic gas
 
Ultrasound transverse view of the left hepatic lobe showing extensive dirty echogenic shadowing in the left hepatic lobe compatible with intrahepatic gas (circle).
 
CT axial image after left hepatectomy.
 
 
 
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