EURORAD ESR

Case 15686

Pyogenic liver abscess and colorectal cancer: an emerging association

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 73 year(s)
 
 
  • Figure 1
    Initial contrast-enhanced multidetector CT
     

    A bilobated, internally fluid lesion (*) centered in the 4th liver segment showed peripheral "rim" enhancement (arrows) and decreased enhancement of adjacent parenchyma (+).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    More caudally, marked (maximum 12 mm) near-circumferential thickening (arrowhead) of cecal wall was noted.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 2
    Percutaneous CT-guided drainage (5 days after Fig.1)
     

    Despite initiation of antibiotics, the liver abscess (*) tended to increase in size with unchanged CT features compared to Fig.1. Additionally, appearance of minimal perihepatic fluid was noted.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Drainage; Special Focus: Abscess;

    Therefore, percutaneous CT-guided puncture and drainage positioning (thick arrows) was performed.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Drainage; Special Focus: Abscess;

    Therefore, percutaneous CT-guided puncture and drainage positioning (thick arrows) was performed.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Drainage; Special Focus: Abscess;
     
     
  • Figure 3
    Post-drainage follow-up CT (a week after Fig.2)
     

    Repeated CT after drainage (thick arrow in a) showed decreased size of the treated liver abscess, with near-complete resolution of internal fluid-like purulent content (* in b).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Repeated CT after drainage (thick arrow in a) showed decreased size of the treated liver abscess, with near-complete resolution of internal fluid-like purulent content (* in b).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 4
    Water-enema CT-colonography after drainage removal
     

    After drainage removal, water-enema CT showed near-complete regression of treated liver abscess (*) and persistence of marked solid mural thickening of cecum (arrowheads) consistent with endoscopic diagnosis of...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    After drainage removal, water-enema CT showed near-complete regression of treated liver abscess (*) and persistence of marked solid mural thickening of cecum (arrowheads) consistent with endoscopic diagnosis of...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    After drainage removal, water-enema CT showed near-complete regression of treated liver abscess (*) and persistence of marked solid mural thickening of cecum (arrowheads) consistent with endoscopic diagnosis of...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 5
    Post-surgical contrast-enhanced CT
     

    Follow-up CT (with peroral bowel opacification) showed normal post-surgical status after right hemicolectomy and lymphadenectomy. Note complete disappearance of treated liver abscess (in a).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Follow-up CT (with peroral bowel opacification) showed normal post-surgical status after right hemicolectomy and lymphadenectomy.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Follow-up CT (with peroral bowel opacification) showed normal post-surgical status after right hemicolectomy and lymphadenectomy.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
A bilobated, internally fluid lesion (*) centered in the 4th liver segment showed peripheral "rim" enhancement (arrows) and decreased enhancement of adjacent parenchyma (+).
 
More caudally, marked (maximum 12 mm) near-circumferential thickening (arrowhead) of cecal wall was noted.
 
Despite initiation of antibiotics, the liver abscess (*) tended to increase in size with unchanged CT features compared to Fig.1. Additionally, appearance of minimal perihepatic fluid was noted.
 
Therefore, percutaneous CT-guided puncture and drainage positioning (thick arrows) was performed.
 
Therefore, percutaneous CT-guided puncture and drainage positioning (thick arrows) was performed.
 
Repeated CT after drainage (thick arrow in a) showed decreased size of the treated liver abscess, with near-complete resolution of internal fluid-like purulent content (* in b).
 
Repeated CT after drainage (thick arrow in a) showed decreased size of the treated liver abscess, with near-complete resolution of internal fluid-like purulent content (* in b).
 
After drainage removal, water-enema CT showed near-complete regression of treated liver abscess (*) and persistence of marked solid mural thickening of cecum (arrowheads) consistent with endoscopic diagnosis of carcinoma.
 
After drainage removal, water-enema CT showed near-complete regression of treated liver abscess (*) and persistence of marked solid mural thickening of cecum (arrowheads) consistent with endoscopic diagnosis of carcinoma.
 
After drainage removal, water-enema CT showed near-complete regression of treated liver abscess (*) and persistence of marked solid mural thickening of cecum (arrowheads) consistent with endoscopic diagnosis of carcinoma.
 
Follow-up CT (with peroral bowel opacification) showed normal post-surgical status after right hemicolectomy and lymphadenectomy. Note complete disappearance of treated liver abscess (in a).
 
Follow-up CT (with peroral bowel opacification) showed normal post-surgical status after right hemicolectomy and lymphadenectomy.
 
Follow-up CT (with peroral bowel opacification) showed normal post-surgical status after right hemicolectomy and lymphadenectomy.
 
 
 
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