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Imaging and Percutaneous Treatment of Secondarily Infected Hepatic Infarctions

Bruce G. Stewart1, Debra A. Gervais1, Mary J. O'Neill1,2, Giles W. Boland1, Peter F. Hahn1 and Peter R. Mueller1

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.


Figure 1
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  		Fig. 1A —72-year-old man (patient 5 in Table 1) who underwent Whipple procedure for pancreatic carcinoma and presented with hepatic infarction that shows interval rounding of secondarily infected infarction when compared with baseline infarction. Contrast-enhanced CT scan shows subtle peripheral wedge-shaped hypodensity (arrow) in segment VI of liver; this finding is consistent with hepatic infarction.

 

Figure 2
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  		Fig. 1B —72-year-old man (patient 5 in Table 1) who underwent Whipple procedure for pancreatic carcinoma and presented with hepatic infarction that shows interval rounding of secondarily infected infarction when compared with baseline infarction. Contrast-enhanced CT scan obtained 53 days after A shows interval rounding (arrow) of segment VI lesion with rim enhancement; these findings are consistent with infected infarction. Purulent fluid from subsequent percutaneous abscess drainage grew {alpha}-hemolytic Streptococcus organisms.

 

Figure 3
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  		Fig. 2A —29-year-old woman (patient 4 in Table 1) who underwent hepatic transplantation for metastatic carcinoid. Images show evolution of appearance of hepatic infarction from baseline examination to secondary infection with abscess formation and intralesional gas. Contrast-enhanced CT scan shows peripheral wedge-shaped lesion in segments II and III (black arrow), which is consistent with hepatic infarction. Linear high-attenuation area (white arrow) anterior to main portal vein represents biliary stent.

 

Figure 4
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  		Fig. 2B —29-year-old woman (patient 4 in Table 1) who underwent hepatic transplantation for metastatic carcinoid. Images show evolution of appearance of hepatic infarction from baseline examination to secondary infection with abscess formation and intralesional gas. Contrast-enhanced CT scan obtained 15 days after A shows interval rounding, intralesional gas formation (black arrow), and rim enhancement; these findings are consistent with infection with abscess formation. Linear high-attenuation area (white arrow) anterior to main portal vein represents biliary stent.

 

Figure 5
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  		Fig. 2C —29-year-old woman (patient 4 in Table 1) who underwent hepatic transplantation for metastatic carcinoid. Images show evolution of appearance of hepatic infarction from baseline examination to secondary infection with abscess formation and intralesional gas. Unenhanced CT scan obtained after procedure shows drainage catheter (arrow) in place. Purulent fluid from percutaneous abscess drainage grew Enterococcus organisms.

 

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