EURORAD ESR

Case 10967

Superinfected hepatic cyst: an unexpected cause of persistent fever

Author(s)
Tonolini Massimo, MD; Roberto Bianco, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 76 year(s)
 
 
  • Figure 1
    (16 months earlier) contrast-enhanced MDCT, unenhanced MRI with MRCP
     

    Sixteen months earlier, contrast-enhanced MDCT revealed some scattered simple liver cysts with fluid attenuation, imperceptible walls, and absent enhancement, the largest one measuring 3.5cm.

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

    Unenhanced T1-(b) and T2-weighted (c,d) MRI images confirmed some simple liver cysts with fluid signal intensity and imperceptible walls, the largest in the 4th segment with 3.5cm maximum diameter.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Cysts;

    Unenhanced T1-(b) and T2-weighted (c,d) MRI images confirmed some simple liver cysts with fluid signal intensity and imperceptible walls, the largest in the 4th segment with 3.5cm maximum diameter.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Cysts;

    Unenhanced T1-(b) and T2-weighted (c,d) MRI images confirmed some simple liver cysts with fluid signal intensity and imperceptible walls, the largest in the 4th segment with 3.5cm maximum diameter.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Cysts;

    After cholecystectomy, MRCP showed minimally dilated left lobar and common bile ducts, with a millimetric filling defect (arrowhead) consistent with choledochal stone. Shortly thereafter, biliary sludge was removed...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Cysts;
     
     
  • Figure 2
    (Currently) Unenhanced and gadolinium-enhanced MRI plus MRCP
     

    Unenhanced T1-(a), T2-weighted (b,c) images show enlarged 4th segment liver cyst compared to baseline, with diffuse contour irregularities, moderately thickened periphery with oedematous signal intensity (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Unenhanced T1-(a), T2-weighted (b,c) images show enlarged 4th segment liver cyst compared to baseline, with diffuse contour irregularities, moderately thickened periphery with oedematous signal intensity (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Unenhanced T1-(a), T2-weighted (b,c) images show enlarged 4th segment liver cyst compared to baseline, with diffuse contour irregularities, moderately thickened periphery with oedematous signal intensity (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    MRCP confirms markedly enlarged dominant liver cyst with internal fluidlike signal intensity, diffusely irregular contour. Stable caliber of minimally dilated left lobe and common bile ducts. Perihepatic effusion is...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Arterial-phase gadolinium-enhanced T1-weighted acquisition shows absent lesional enhancement, hyperenhancement (+) of the surrounding liver parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Venou-phase gadolinium-enhanced T1-weighted acquisition shows lesion with absent internal enhancement, hyperenhancement of the minimally thickened peripheral "rim" (arrows).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Contrast-enhanced detail MRI images (g…i) exclude abnormal inflammatory mural enhancement of the intrahepatic and common (arrowhead) bile ducts indicating active infectious cholangitis.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Contrast-enhanced detail MRI images (g…i) exclude abnormal inflammatory mural enhancement of the intrahepatic and common (arrowhead) bile ducts indicating active infectious cholangitis.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;

    Contrast-enhanced detail MRI images (g…i) exclude abnormal inflammatory mural enhancement of the intrahepatic and common (arrowhead) bile ducts indicating active infectious cholangitis.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Abscess delineation; Special Focus: Abscess;
     
     
  • Figure 3
    Unenhanced MDCT after percutaneous drainage positioning
     

    Axial (a) and coronal (b) images confirm partially drained 4th segment liver abscess shortly after drainage positioning.

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

    Axial (a) and coronal (b) images confirm partially drained 4th segment liver abscess shortly after drainage positioning.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Drainage; Special Focus: Abscess;
     
     
Sixteen months earlier, contrast-enhanced MDCT revealed some scattered simple liver cysts with fluid attenuation, imperceptible walls, and absent enhancement, the largest one measuring 3.5cm.
 
Unenhanced T1-(b) and T2-weighted (c,d) MRI images confirmed some simple liver cysts with fluid signal intensity and imperceptible walls, the largest in the 4th segment with 3.5cm maximum diameter.
 
Unenhanced T1-(b) and T2-weighted (c,d) MRI images confirmed some simple liver cysts with fluid signal intensity and imperceptible walls, the largest in the 4th segment with 3.5cm maximum diameter.
 
Unenhanced T1-(b) and T2-weighted (c,d) MRI images confirmed some simple liver cysts with fluid signal intensity and imperceptible walls, the largest in the 4th segment with 3.5cm maximum diameter.
 
After cholecystectomy, MRCP showed minimally dilated left lobar and common bile ducts, with a millimetric filling defect (arrowhead) consistent with choledochal stone. Shortly thereafter, biliary sludge was removed during Endoscopic Retrograde Cholangiopancreatography and sphincterotomy.
 
Unenhanced T1-(a), T2-weighted (b,c) images show enlarged 4th segment liver cyst compared to baseline, with diffuse contour irregularities, moderately thickened periphery with oedematous signal intensity (arrowheads).
 
Unenhanced T1-(a), T2-weighted (b,c) images show enlarged 4th segment liver cyst compared to baseline, with diffuse contour irregularities, moderately thickened periphery with oedematous signal intensity (arrowheads).
 
Unenhanced T1-(a), T2-weighted (b,c) images show enlarged 4th segment liver cyst compared to baseline, with diffuse contour irregularities, moderately thickened periphery with oedematous signal intensity (arrowheads).
 
MRCP confirms markedly enlarged dominant liver cyst with internal fluidlike signal intensity, diffusely irregular contour. Stable caliber of minimally dilated left lobe and common bile ducts. Perihepatic effusion is present.
 
Arterial-phase gadolinium-enhanced T1-weighted acquisition shows absent lesional enhancement, hyperenhancement (+) of the surrounding liver parenchyma.
 
Venou-phase gadolinium-enhanced T1-weighted acquisition shows lesion with absent internal enhancement, hyperenhancement of the minimally thickened peripheral "rim" (arrows).
 
Contrast-enhanced detail MRI images (g…i) exclude abnormal inflammatory mural enhancement of the intrahepatic and common (arrowhead) bile ducts indicating active infectious cholangitis.
 
Contrast-enhanced detail MRI images (g…i) exclude abnormal inflammatory mural enhancement of the intrahepatic and common (arrowhead) bile ducts indicating active infectious cholangitis.
 
Contrast-enhanced detail MRI images (g…i) exclude abnormal inflammatory mural enhancement of the intrahepatic and common (arrowhead) bile ducts indicating active infectious cholangitis.
 
Axial (a) and coronal (b) images confirm partially drained 4th segment liver abscess shortly after drainage positioning.
 
Axial (a) and coronal (b) images confirm partially drained 4th segment liver abscess shortly after drainage positioning.
 
 
 
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