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Low Mechanical Index Contrast-Enhanced Sonographic Findings of Pyogenic Hepatic Abscesses

¹ All authors: Department of Radiology, S. Maria delle Grazie Hospital, Via Domitiana Località La Schiana, Pozzuoli, Naples 80121, Italy.

View larger version (156K): [in a new window]   Fig. 1A. —39-year-old woman with right upper quadrant pain and leukocytosis. Contrast-enhanced sonogram obtained 50 sec after injection shows oval lesion (arrows) with enhancing rim and multiple peripheral enhancing septa.

View larger version (125K): [in a new window]   Fig. 1B. —39-year-old woman with right upper quadrant pain and leukocytosis. Contrast-enhanced early phase CT scan shows lesion (arrowheads) similar to that in A.

View larger version (160K): [in a new window]   Fig. 2A. —44-year-old woman with right upper quadrant pain and fever. Contrast-enhanced sonogram obtained 20 sec after injection shows abscess (arrowheads). Note thin enhancing rim and discrete arteries running along wall and single complete internal septum.

View larger version (151K): [in a new window]   Fig. 2B. —44-year-old woman with right upper quadrant pain and fever. Contrast-enhanced sonogram obtained 60 sec after injection shows abscess (arrowheads). Note clear depiction of margin between enhancing parenchyma around abscess and nonenhancing collection.

View larger version (155K): [in a new window]   Fig. 2C. —44-year-old woman with right upper quadrant pain and fever. Contrast-enhanced portal phase CT scan confirms fluid lesion (arrows) but fails to reveal internal septum. Note peripheral area of hypoperfusion (arrowheads).

View larger version (172K): [in a new window]   Fig. 3A. —40-year-old diabetic man with persistent pain and fever 2 weeks after right pyelostomy for pyonephrosis. Contrast-enhanced portal phase CT scan shows inhomogeneously hypoattenuating and possibly solid lesion (arrows) that appears metastatic.

View larger version (142K): [in a new window]   Fig. 3B. —40-year-old diabetic man with persistent pain and fever 2 weeks after right pyelostomy for pyonephrosis. Baseline sonogram shows nonspecific inhomogeneously hypoechoic and ill-defined lesion (arrowheads).

View larger version (140K): [in a new window]   Fig. 3C. —40-year-old diabetic man with persistent pain and fever 2 weeks after right pyelostomy for pyonephrosis. Contrast-enhanced sonogram of mass (arrowheads) obtained 70 sec after injection shows unsuspected complex internal structure with incomplete enhancing rim and some enhancing regular internal septa. New hypothesis of nonliquefied abscess was confirmed at aspiration.

View larger version (133K): [in a new window]   Fig. 4A. —78-year-old woman undergoing conventional sonography because of 2-month history of mild flank pain. Baseline sonogram shows ill-defined inhomogeneous and slightly hypoechoic lesion (arrow), originally hypothesized to be metastasis.

View larger version (142K): [in a new window]   Fig. 4B. —78-year-old woman undergoing conventional sonography because of 2-month history of mild flank pain. Contrast-enhanced sonogram of lesion (arrow) obtained 20 sec after injection shows rim enhancement with internal hypoechogenicity.

View larger version (156K): [in a new window]   Fig. 4C. —78-year-old woman undergoing conventional sonography because of 2-month history of mild flank pain. Contrast-enhanced sonogram of lesion (arrow) obtained 30 sec after injection shows centripetal opacification of internal septa. Note perilesional hyperemic echogenicity (arrowheads).

View larger version (156K): [in a new window]   Fig. 4D. —78-year-old woman undergoing conventional sonography because of 2-month history of mild flank pain. Contrast-enhanced sonogram of lesion (arrow) obtained 60 sec after injection shows internal honeycomblike reticular pattern. Early phase echogenicity around abscess seen in C has disappeared.

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