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Hepatic Attenuation Differences Associated with Obstruction of the Portal or Hepatic Veins in Patients with Hepatic Abscess

Kyoung Ho Lee1, Joon Koo Han2, Jun Yong Jeong2, Young Jun Kim2, Hak Jong Lee1, Seong Ho Park3 and Byung Ihn Choi2

1 Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
2 Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
3 Department of Radiology, University of Ulsan College of Medicine 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.



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  		Fig. 1A —Transverse dynamic CT images in 47-year-old man with hepatic abscess. CT scan obtained during hepatic artery phase shows wedge-shaped regional hyperattenuation (e) in hepatic parenchyma surrounding abscess (a).

 


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  		Fig. 1B —Transverse dynamic CT images in 47-year-old man with hepatic abscess. This regional parenchymal hyperattenuation returned to normal during portal venous phase. Note that posterior branch of right portal vein is thrombosed (arrow).

 


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  		Fig. 2A —Transverse dynamic CT images in 76-year-old man with hepatic abscess. CT scan obtained during hepatic artery phase shows regional hyperattenuation (e) in hepatic parenchyma surrounding abscess (a). Arrowhead indicates hepatic artery at segment II.

 


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  		Fig. 2B —Transverse dynamic CT images in 76-year-old man with hepatic abscess. This regional parenchymal hyperattenuation returned to normal during portal venous phase. Note stenosis (open arrows, B) and thrombosis (curved arrow, C) of left portal vein in contact with abscess (a in C). Note also periportal low-attenuation cuff, which extends to other hepatic regions. Arrowhead in C indicates hepatic artery at segment II, white arrows indicate wall or septation of abscess.

 


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  		Fig. 2C —Transverse dynamic CT images in 76-year-old man with hepatic abscess. This regional parenchymal hyperattenuation returned to normal during portal venous phase. Note stenosis (open arrows, B) and thrombosis (curved arrow, C) of left portal vein in contact with abscess (a in C). Note also periportal low-attenuation cuff, which extends to other hepatic regions. Arrowhead in C indicates hepatic artery at segment II, white arrows indicate wall or septation of abscess.

 


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  		Fig. 3A —Transverse dynamic CT images in 55-year-old man with hepatic abscess. CT scans obtained during hepatic arterial (A) and portal venous (B and C) phases, show thrombosis of right hepatic vein (open arrows, B and C) adjacent to hepatic abscess (a in A and B) and normal opacification of middle hepatic vein (curved arrow, B). Note regional hypoattenuation (o in B and C), and smaller hyperattenuated area (e in A) in hepatic parenchyma surrounding abscess. Vertex of wedge-shaped hypoattenuating area points to inferior vena cava (I in B and C). Note dilated intrahepatic bile ducts in left liver (white arrows, B and C).

 


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  		Fig. 3B —Transverse dynamic CT images in 55-year-old man with hepatic abscess. CT scans obtained during hepatic arterial (A) and portal venous (B and C) phases, show thrombosis of right hepatic vein (open arrows, B and C) adjacent to hepatic abscess (a in A and B) and normal opacification of middle hepatic vein (curved arrow, B). Note regional hypoattenuation (o in B and C), and smaller hyperattenuated area (e in A) in hepatic parenchyma surrounding abscess. Vertex of wedge-shaped hypoattenuating area points to inferior vena cava (I in B and C). Note dilated intrahepatic bile ducts in left liver (white arrows, B and C).

 


View larger version (131K):

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  		Fig. 3C —Transverse dynamic CT images in 55-year-old man with hepatic abscess. CT scans obtained during hepatic arterial (A) and portal venous (B and C) phases, show thrombosis of right hepatic vein (open arrows, B and C) adjacent to hepatic abscess (a in A and B) and normal opacification of middle hepatic vein (curved arrow, B). Note regional hypoattenuation (o in B and C), and smaller hyperattenuated area (e in A) in hepatic parenchyma surrounding abscess. Vertex of wedge-shaped hypoattenuating area points to inferior vena cava (I in B and C). Note dilated intrahepatic bile ducts in left liver (white arrows, B and C).

 


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  		Fig. 4A —Transverse dynamic CT images in 79-year-old man with hepatic abscess. CT scan obtained during hepatic artery phase shows wedge-shaped regional parenchymal hyperattenuation (e) in hepatic parenchyma surrounding an abscess (a) that ruptured into peritoneal cavity. Left portal vein (l in A) is highly opacified compared with right portal vein (r in B), indicating presence of arterioportal shunt. Note periportal low-attenuation cuff surrounding left portal vein and air within bile ducts (b).

 


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  		Fig. 4B —Transverse dynamic CT images in 79-year-old man with hepatic abscess. CT scan obtained during hepatic artery phase shows wedge-shaped regional parenchymal hyperattenuation (e) in hepatic parenchyma surrounding an abscess (a) that ruptured into peritoneal cavity. Left portal vein (l in A) is highly opacified compared with right portal vein (r in B), indicating presence of arterioportal shunt. Note periportal low-attenuation cuff surrounding left portal vein and air within bile ducts (b).

 


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  		Fig. 4C —Transverse dynamic CT images in 79-year-old man with hepatic abscess. During portal venous phase, left hepatic vein was not identified except for small central portion (solid arrow), whereas middle and right hepatic veins were normally opacified (open arrows). a = abscess, e = hyperattenuation.

 

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