الموقع الرسمي للدكتور أحمد رفاعي

  • الرئيسية
  • محاضراتي - فيديو
  • محاضراتي - بور بوينت
  • case of the week
  • أعمال من تصويري
  • أعمال من رسوماتي
  • قصص قصيرة
  • اتصل بنا

Case No ; 6

1/16/2013

1 Comment

 
Picture







Findings:

·     A low attenuated mass lesion involving most of the left lobe of the liver       ( red
arrow
  with liquefied center showing multiple internal septations and shaggy outline.

·       In  more caudal cuts, there are features of acute appendicitis seen in the form of enhancing thickened appendix with retained intraluminal fluid ( yellow arrow).

 Diagnosis :
Pyogenic liver abscess due to acute appenditis.

 Teaching points:

· Two types of liver abscesses: 
pyogenic and amebic .      
.  Amoebic liver abscess is usually solitary, subcapsularly located. The route of infection is via
intestinal amoebiasis, treated by conservative treatment.
 ·       Pyogenic liver abscess is usually multiple, multiloculated,  formed of multiple small abscesses coalescing together forming a large cavity with shaggy outline, may contain air and in such cases it is a pathognomonic feature,  must be drained and treated with antibiotics
 ·       The route of infection is via 5 sources :
 -        through hepatic artery from any systemic septic focus   like osteomyelitis or
sinusitis
 -        through portal vein such as appendicitis or diverticulitis
 -        through CBD in ascending cholangitis
 -        Direct spread from contiguous infection like cholecystitis or peptic ulcer
 -        In cases of penetrating trauma.
……………………………………………………………………………………
* CT features of acute appendicitis
: appendix is more than 7 mm in diameter, thickened enhanced wall, appendicolith
( intraluminal stone), periappndiceal inflammatory changes ( fat stranding) , or fluid collection and extraluminal air ( signs of perforation

1 Comment
Muhamad Abdel Hamed
1/23/2013 07:18:10 am

Nice case

Reply



Leave a Reply.