Detection of Liver Abscesses by T1-Weighted Magnetic Resonance Imaging

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     A 68-year-old man presented with pain in the right upper abdomen and a temperature above 39°C. Although he had recently undergone a five-day course of treatment with broad-spectrum antibiotics at another hospital, the patient's white-cell count was 13,010 per cubic millimeter, with 81.2 percent neutrophils, 8.1 percent monocytes, 9.8 percent lymphocytes, 0.1 percent basophils, and 0.8 percent eosinophils. On physical examination, no abnormalities were detected. The liver and spleen were not enlarged, and there was no abdominal tenderness. The patient did not have polycystic kidney or liver disease, and there was no family history of these diseases. Computed tomographic scanning of the abdomen without the use of intravenous contrast material showed multiple cystic lesions in the liver (Panel A), as did scanning with the use of contrast material. T1-weighted magnetic resonance imaging study revealed a high-intensity region in a single cyst that was located in the right posterior segment of the liver (Panel B, arrow). Transhepatic drainage of this lesion was performed with ultrasonographic guidance. Approximately 20 ml of muddy-appearing fluid was obtained; it contained 5.3 g per deciliter of protein and many white cells and red cells, but no bacteria were detected on Gram's staining or in culture. One day after the fluid had been drained, the patient's fever abated, and the white-cell count and differential count returned rapidly to normal.

    Masanori Nakagawara, M.D.

    Seirei Hamamatsu General Hospital

    Hamamatsu 430-8558, Japan

    Hiroyuki Hanai, M.D.

    Hamamatsu University of Medicine

    Hamamatsu 431-3192, Japan

    Masayoshi Kajimura, M.D.

    Seirei Hamamatsu General Hospital

    Hamamatsu 430-8558, Japan

    http://www.100md.com/html/DirDu/2006/11/29/30/62/68.htm