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Imaging and Percutaneous Treatment of Secondarily Infected Hepatic Infarctions

¹ Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114.
² Present address: Beverly Radiology Associates, Inc., Beverly Hospital, Beverly, MA.

OBJECTIVE. The objective of our study was to describe the imaging features and success rate of percutaneously treated infected hepatic infarctions.

MATERIALS AND METHODS. Three hundred ninety-two patients had percutaneous liver abscess aspiration and drainage or aspiration and intraoperative débridement at our institution between 1990 and 2003. One hundred fifty-one of these patients underwent CT at least 2 days before the drainage procedure and immediately before the procedure. Retrospective review of the imaging and medical records identified 13 patients with microbiologically documented liver abscesses who had liver lesions consistent with hepatic infarction on the baseline CT.

RESULTS. Twenty-one hepatic infarctions in 13 patients were documented on baseline CT, 15 of which became secondarily infected. Ten of 15 patients with infected infarctions had undergone either hepatic transplantation or the Whipple procedure. Although the left lobe was slightly more commonly infarcted than the right lobe (54% vs 46%, respectively), right lobe infarctions were more commonly superinfected than left lobe infarctions (61% vs 39%); however, neither of these distinctions was statistically significant. Twelve of 13 patients underwent percutaneous drainage. The duration of catheter drainage was significantly longer in patients in whom catheter drainage was complicated by biliary communication than those without biliary communication (61 vs 19 days, respectively). Eleven of 12 patients (92%) responded to drainage such that they survived to discharge from the hospital.

CONCLUSION. Patients with hepatic infarctions are at risk for secondary infection, particularly those patients having undergone surgery involving the porta hepatis. Percutaneous abscess drainage can be performed safely with excellent technical and clinical outcomes in this complex patient population.

Keywords: abscess drainage • hepatic infarction • hepatic transplantation • polymicrobial infections • superinfection • Whipple procedure

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