EURORAD ESR

Case 12794

Postoperative abscess following wedge hepatic resection

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, 61 year(s)
 
 
  • Figure 1
    Preoperative contrast-enhanced total-body multidetector CT
     

    Axial (a) and coronal (b) images from follow-up CT showed appearance of tiny sub-centimetre hypoenhancing lesion (short arrows) consistent with metachronous metastasis in the 5th liver segment. No other signs of...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Metastases;

    Axial (a) and coronal (b) images from follow-up CT showed appearance of tiny sub-centimetre hypoenhancing lesion (short arrows) consistent with metachronous metastasis in the 5th liver segment. No other signs of...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Metastases;
     
     
  • Figure 2
    Emergency contrast-enhanced multidetector CT on 5th postoperative day
     

    At the right lung base pleural effusion (+) and pneumonic-atelectatic consolidation involving most of the lower pulmonary lobe were noted.

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

    Multiplanar CT images showed minimal residual pneumoperitoneum (short arrow), a large (15x6 cm) hypoattenuating subcapsular collection (*) with interspersed gas bubbles. Note pleuropulmonary changes (+), metallic...

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

    Multiplanar CT images showed minimal residual pneumoperitoneum (arrowheads), a large (15x6 cm) hypoattenuating subcapsular collection (*) with interspersed gas bubbles. Note metallic clips (thin arrows), patent...

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

    Coronal and sagittal reformatted images showed the entire longitudinal extent of the postoperative subphrenic abscess (*) originating from the resection site, with interspersed gas bubbles. Note pleuropulmonary...

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

    Coronal and sagittal reformatted images showed the entire longitudinal extent of the postoperative subphrenic abscess (*) originating from the resection site, with interspersed gas bubbles. Note pleuropulmonary...

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

    Additionally, the postoperative abscess (*) contained a 3 cm strongly hypoattenuating discoidal structure containing confluent gas-like attenuation, consistent with bioabsorbable haemostatic agent (arrowhead). Note...

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

    Additionally, the postoperative abscess (*) contained a 3 cm strongly hypoattenuating discoidal structure containing confluent gas-like attenuation, consistent with bioabsorbable haemostatic agent (arrowhead). Note...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Complications; Special Focus: Abscess;
     
     
  • Figure 3
    CT-guided percutaneous drainage positioning
     

    Unenhanced CT images documented percutaneous positioning of drainage (arrows) in the postoperative abscess collection.

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

    Unenhanced CT images documented percutaneous positioning of drainage (arrows) in the postoperative abscess collection.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Drainage; Special Focus: Abscess;
     
     
  • Figure 4
    Repeated contrast-enhanced multidetector CT 6 days after drainage
     

    Six days later CT showed cleared right lung base, persistence of minimal pneumoperitoneum (arrowheads), minimal size decrease of the postoperative abscess (*). Note clips (thin arrows), drainage tube (arrows).

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

    Six days later CT showed minimal size decrease of the postoperative abscess (*). Note clips (thin arrows), drainage tube (arrows), patent hepatic veins and portal venous system.

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

    Six days later CT showed minimal size decrease of the postoperative abscess (*). Note clips (thin arrows), drainage tube (arrows), patent hepatic veins and portal venous system.

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

    Six days later CT showed minimal size decrease of the postoperative abscess (*), initial regression of the discoidal bioabsorbable haemostatic agent (arrowhead). Note clips (thin arrows), drainage tube (arrows).

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

    Six days later CT showed minimal size decrease of the postoperative abscess (*) and initial regression of the discoidal bioabsorbable haemostatic agent (arrowhead). Note clips (thin arrows), drainage (arrows), patent...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Complications; Special Focus: Abscess;
     
     
  • Figure 5
    Contrast-enhanced multidetector CT 25 days after surgery
     

    Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube...

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

    Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube...

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

    Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube...

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

    Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Complications; Special Focus: Abscess;
     
     
  • Figure 6
    Fluoroscopy-guided drainage replacement
     

    Initial fluoroscopic image demonstrated positioning of the percutaneous drainage with distal apex in the lower portion of the postoperative abscess.

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

    After replacement, the new multi-hole drainage appeared coiled in the upper portion of the postoperative abscess.

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

    After replacement, the new multi-hole drainage appeared coiled in the upper portion of the postoperative abscess, with the lower portion opacified by injection of contrast medium.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Drainage; Special Focus: Abscess;
     
     
  • Figure 7
    Repeated contrast-enhanced multidector CT 3 weeks after discharge
     

    After drainage (arrows) replacement, follow-up CT documented near-complete regression of the postoperative abscess.

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

    After drainage (arrows) replacement, follow-up CT documented near-complete regression of the postoperative abscess.

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

    After drainage (arrows) replacement, follow-up CT documented near-complete regression of the postoperative abscess.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Complications; Special Focus: Abscess;
     
     
  • Figure 8
    Follow-up contrast-enhanced multidetector CT 6 months after surgery
     

    Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence.

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

    Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence. Note residual metallic clips.

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

    Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence. Note residual metallic clips.

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

    Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence. Note residual metallic clips.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Complications; Special Focus: Abscess;
     
     
Axial (a) and coronal (b) images from follow-up CT showed appearance of tiny sub-centimetre hypoenhancing lesion (short arrows) consistent with metachronous metastasis in the 5th liver segment. No other signs of neoplastic recurrence were seen.
 
Axial (a) and coronal (b) images from follow-up CT showed appearance of tiny sub-centimetre hypoenhancing lesion (short arrows) consistent with metachronous metastasis in the 5th liver segment. No other signs of neoplastic recurrence were seen.
 
At the right lung base pleural effusion (+) and pneumonic-atelectatic consolidation involving most of the lower pulmonary lobe were noted.
 
Multiplanar CT images showed minimal residual pneumoperitoneum (short arrow), a large (15x6 cm) hypoattenuating subcapsular collection (*) with interspersed gas bubbles. Note pleuropulmonary changes (+), metallic clips (thin arrows).
 
Multiplanar CT images showed minimal residual pneumoperitoneum (arrowheads), a large (15x6 cm) hypoattenuating subcapsular collection (*) with interspersed gas bubbles. Note metallic clips (thin arrows), patent hepatic veins and portal venous system.
 
Coronal and sagittal reformatted images showed the entire longitudinal extent of the postoperative subphrenic abscess (*) originating from the resection site, with interspersed gas bubbles. Note pleuropulmonary changes (+), metallic clips (thin arrows).
 
Coronal and sagittal reformatted images showed the entire longitudinal extent of the postoperative subphrenic abscess (*) originating from the resection site, with interspersed gas bubbles. Note pleuropulmonary changes (+), minimal residual pneumoperitoneum (short arrow), clips (thin arrows).
 
Additionally, the postoperative abscess (*) contained a 3 cm strongly hypoattenuating discoidal structure containing confluent gas-like attenuation, consistent with bioabsorbable haemostatic agent (arrowhead). Note pleuropulmonary changes (+), minimal residual pneumoperitoneum (short arrow).
 
Additionally, the postoperative abscess (*) contained a 3 cm strongly hypoattenuating discoidal structure containing confluent gas-like attenuation, consistent with bioabsorbable haemostatic agent (arrowhead). Note pleuropulmonary changes (+), metallic clips (thin arrows).
 
Unenhanced CT images documented percutaneous positioning of drainage (arrows) in the postoperative abscess collection.
 
Unenhanced CT images documented percutaneous positioning of drainage (arrows) in the postoperative abscess collection.
 
Six days later CT showed cleared right lung base, persistence of minimal pneumoperitoneum (arrowheads), minimal size decrease of the postoperative abscess (*). Note clips (thin arrows), drainage tube (arrows).
 
Six days later CT showed minimal size decrease of the postoperative abscess (*). Note clips (thin arrows), drainage tube (arrows), patent hepatic veins and portal venous system.
 
Six days later CT showed minimal size decrease of the postoperative abscess (*). Note clips (thin arrows), drainage tube (arrows), patent hepatic veins and portal venous system.
 
Six days later CT showed minimal size decrease of the postoperative abscess (*), initial regression of the discoidal bioabsorbable haemostatic agent (arrowhead). Note clips (thin arrows), drainage tube (arrows).
 
Six days later CT showed minimal size decrease of the postoperative abscess (*) and initial regression of the discoidal bioabsorbable haemostatic agent (arrowhead). Note clips (thin arrows), drainage (arrows), patent hepatic veins and portal venous system.
 
Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube (arrows).
 
Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube (arrows).
 
Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube (arrows).
 
Before discharge, repeated CT showed the postoperative abscess (*) with minimally decreased size, more homogeneous content, disappearance of the bioabsorbable haemostatic agent. Note clips (thin arrows), drainage tube (arrows).
 
Initial fluoroscopic image demonstrated positioning of the percutaneous drainage with distal apex in the lower portion of the postoperative abscess.
 
After replacement, the new multi-hole drainage appeared coiled in the upper portion of the postoperative abscess.
 
After replacement, the new multi-hole drainage appeared coiled in the upper portion of the postoperative abscess, with the lower portion opacified by injection of contrast medium.
 
After drainage (arrows) replacement, follow-up CT documented near-complete regression of the postoperative abscess.
 
After drainage (arrows) replacement, follow-up CT documented near-complete regression of the postoperative abscess.
 
After drainage (arrows) replacement, follow-up CT documented near-complete regression of the postoperative abscess.
 
Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence.
 
Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence. Note residual metallic clips.
 
Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence. Note residual metallic clips.
 
Long-term (6 months) follow-up demonstrated resolution of the postoperative abscess after drainage removal. No signs of local or distant neoplastic recurrence. Note residual metallic clips.
 
 
 
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