Hepatic Cyst Infection Research Articles

Diagnostic Performance of 18-Fluorodeoxyglucose Positron-Emission Tomography-Computed Tomography (18F-FDG PET-CT) in the Detection of Autosomal Dominant Polycystic Kidney Disease Cyst Infections: A Meta-Analysis.

Diagnosing suspected renal or hepatic infections in autosomal dominant polycystic kidney disease (ADPKD) is difficult. Although 18-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET-CT) is recommended to aid in the diagnosis, there is no consensus about its diagnostic accuracy. We aimed to investigate its diagnostic performance. To further assess this, we performed a meta-analysis. A comprehensive literature search screening of PubMed/MEDLINE, Embase, and Cochrane library databases through February 2024 was performed. Pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and C-reactive protein (CRP) were estimated using the random effects model. Heterogeneity between studies was estimated using CochranQ and I2 statistics. A total of seven studies were included in the final analysis. The pooled sensitivity of 18F-FDG PET-CT in diagnosing kidney and hepatic cyst infection was 82.6% (95% CI: 73.8-88.9; I2 16.9%), specificity was 77.6% (95% CI: 66.7-85.7; I2 15.6%), PPV was 79.4% (95% CI: 62.4-89.9; I2 62.6%), and NPV was 81.3% (95% CI: 72.7-87.7; I2 0%). The mean CRP was 244.2 mg/L (95% CI: 209.1-279.1; I2 66%).The results showed that18F-FDG PET-CT demonstrated excellent pooled diagnostic performance in diagnosing renal and hepatic cyst infections in ADPKD.

Cystogastrostomy as an alternative treatment for recurrent huge infected hepatic cyst.

Cystogastrostomy as an alternative treatment for recurrent huge infected hepatic cyst.

Standardized 4-point scoring scale of [18F]-FDG PET/CT imaging helps in the diagnosis of renal and hepatic cyst infections in patients with autosomal dominant polycystic kidney disease: a validation cohort.

Autosomal dominant polycystic kidney disease (ADPKD) is prone to multiple complications, including cyst infection (CyI). 2-Deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) imaging has proved useful in the diagnosis of renal and hepatic CyI. A 4-point scale comparing the uptake of [18F]-FDG in the suspected infected cyst versus the hepatic physiological background has been recently proposed. We performed an independent validation of this semi-quantitative scoring system. All ADPKD patients hospitalized between January 2009 and November 2019 who underwent an [18F]-FDG PET/CT for suspected CyI were retrospectively identified using computer-based databases. Medical files were reviewed. CyI was conventionally defined by the combination of fever (≥38°C), abdominal pain, increased plasma C-reactive protein levels (≥70mg/L), absence of any other cause of inflammation and favourable outcome after ≥21days of antibiotics. [18F]-FDG uptake of the suspected CyI was evaluated using a 4-point scale comparing the uptake of [18F]-FDG around the infected cysts with the uptake in the hepatic parenchyma. Statistics were performed using SAS version 9.4. Fifty-one [18F]-FDG PET/CT scans in 51 patients were included, of which 11 were cases of CyI. The agreement between the 4-point scale and the gold-standard criteria of CyI was significant [odds ratio of 6.03 for CyI in case of a score ≥3 (P = .014)]. The corresponding sensitivity, specificity, and positive and negative predictive values of [18F]-FDG PET/CT using the 4-point scale were 64% [Clopper-Pearson 95% confidence interval (CI) 30%-89%], 78% (95% CI 62%-89%), 44% (95% CI 20%-70%) and 89% (95% CI 73%-97%), respectively. Our independent validation cohort confirms the use of a semi-quantitative 4-point scoring system of [18F]-FDG PET/CT imaging in the diagnosis of CyI in patients with ADPKD. Considering its performance metrics with high specificity and negative predictive value, the scoring system is particularly useful to distinguish other causes of clinical inflammation than CyI and as such avoid unnecessarily long antibiotic treatment.

Percutaneous drainage of an infected hepatic cyst, responsible for obstructive jaundice by compression on the intrahepatic biliary tract

Hepatic cysts consist of a heterogeneous group of lesions that differ in etiology, prevalence, and clinical manifestations. Liver cystic lesions fall into two main categories: congenital and acquired. Congenital cystic lesions of the liver include polycystic liver disease, simple cysts, ciliated and duct-related liver cysts. Acquired liver cysts are further divided into infected and non-infected. There are two types of infected cysts, parasitic ones (hydatid cysts and amoebic abscesses) and non-parasitic ones, or pyogenic liver abscesses. Infection is a serious complication of cystic liver disease, which can lead to sepsis and death. A diagnosis of cystic infection is usually made by culturing pathogens from the fluid aspirated from the cyst. If an aspirate is not available for testing, the diagnosis of a liver cyst complicated by infection is made by correlating clinical, biochemical, and imaging findings. Infected liver cysts and liver abscesses can be caused by the portal spread of intra-abdominal infections (e.g., appendicitis, diverticulitis, colitis). The placement of a percutaneous drainage catheter allows controlled aspiration of large abscesses for a short-medium period with minimal hemodynamics and physiological stress for the patient. Furthermore, compared to surgical drainage, the results are comparable, while the morbidity is lower.

Microbiome of infected cysts, feces and saliva in patients with autosomal dominant polycystic kidney disease.

Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD). Hematogenous spread via bacterial translocation in the intestine is considered to be the main cause, so intestinal flora may be involved. However, the exact role of the intestinal flora in cyst infection in ADPKD is unknown. We report a 66-year-old woman and a 56-year-old man with ADPKD who had severe hepatic cyst infection. We analyzed the microbiome of infected cyst content, feces, and saliva in these two patients. The microbiome of patient 1 showed various bacteria in an infected cyst, whereas that of patient 2 showed only one bacterium. In both patients, the composition of the microbiome of the cyst content was quite different from those of feces and saliva, and the main bacteria in the infected cyst content represented a small proportion of those in feces and saliva. Lactobacilli were not almost detected in the infected cyst content though some lactobacilli are endemic in the gastrointestinal tract and the saliva. The association between bacteria in cysts and those in feces or saliva remains uncertain, and further research on this topic is needed.

Standardized 4-point scoring scale of [18F]-FDG PET/CT imaging helps in the diagnosis of renal and hepatic cyst infections in patients with autosomal dominant polycystic kidney disease: A validation cohort

Autosomal dominant polycystic kidney disease (ADPKD) is prone to multiple complications, including cyst infection (CyI). [18F]-FDG PET/CT imaging proved useful in the diagnosis of renal and hepatic CyI. A 4-point scale comparing the uptake of [18F]-FDG in the suspected infected cyst versus the hepatic physiological background has been proposed. We performed an independent validation of this semi-quantitative scoring system. All ADPDK patients hospitalized between January 2009 and November 2019 who underwent an [18F]-FDG PET/CT for suspected CyI were retrospectively identified using computer-based databases. Medical files were systematically reviewed. CyI was conventionally defined by the combination of fever (> 38 °C), abdominal pain, increased plasma CRP levels (≥ 70 mg/L), absence of any other cause of inflammation, and favorable outcome after ≥ 21 days of antibiotics. [18F]-FDG uptake of the suspected CyI was evaluated using a 4-point scale comparing the uptake of [18F]-FDG around the infected cysts to the uptake in the hepatic parenchyma. Statistics were performed using SAS version 9.4. Fifty-one [18F]-FDG PET/CT scans in 51 patients were included, of which 11 cases of CyI. The agreement between the 4-point scale and the gold-standard criteria of CyI was significant, with an odds ratio of 6.03 for CyI in case of a score ≥ 3 ( P 0.014). The corresponding sensitivity and specificity of [18F]-FDG PET/CT using the 4-point scale were 63.6% and 77.5%, respectively. Our independent validation cohort confirms the use of a semi-quantitative 4-point scoring system of [18F]-FDG PET/CT imaging in the diagnosis of CyI in patients with ADPKD.

MO011: The Use of a 4-Point Scoring Scale in 18F-FDG-PET/CT Imaging Helps for Diagnosis of Renal and Hepatic CYST Infections in Patients with Autosomal Dominant Polycystic Kidney Disease: A Validation Cohort

Abstract BACKGROUND AND AIMS Autosomal dominant polycystic kidney disease (ADPKD) is prone to multiple complications, including cyst infection (CyI). 18F-FDG PET/CT imaging proved useful in the diagnosis of renal and hepatic CyI. A 4-point scale comparing the uptake of 18F-FDG in the suspected infected cyst versus the hepatic physiological background has been proposed. We performed an independent validation of this semi-quantitative score system. METHOD All ADPDK patients hospitalized between January 2007 and March 2019 who underwent an 18F-FDG PET/CT for suspected CyI were retrospectively identified using computer-based databases. Medical files were systematically reviewed. CyI was conventionally defined by: fever (>38°C), abdominal pain, increased plasma CRP levels (≥70 mg/dL), absence of any other cause of inflammation and favorable outcomes after ≥21 days of antibiotics. The 18F-FDG uptake around the suspected CyI was evaluated using the 4-point scale. Stats were performed using SAS version 9.4. RESULTS Our cohort included 51 18F-FDG PET/CT in 51 patients, including 11 cases of CyI according to the above-detailed definition. The agreement between the 4-point scale and the gold-standard criteria of CyI was significant, with an odds ratio of 6.03 for CyI in case of a score ≥3 (P, 0.014). The corresponding sensitivity and specificity of PET/CT using the 4-point scale were 63.3% and 77.5%, respectively. CONCLUSION Our independent validation cohort confirms that the use of a semi-quantitative 4-point scoring system helps in the diagnosis of CyI by 18F-FDG PET/CT imaging in patients with ADPKD.

Infected Hepatic Cyst in A Patient Diagnosed by Air-fluid Level in An Abdominal Plain Film-A Case Report

在臨床上，腹部超音波檢查常發現肝囊腫，然而，感染性肝囊腫相對少見，因此，我們今天報告一例68歲男性因為腹部直立式X光照片上腹區域發現氣－液平面而診斷感染性肝囊腫的病人，其症狀於放置穿皮經肝引流管後迅速改善，是第一例多毛擬桿菌感染性肝囊腫報告的個案。希望我們的診斷與治療經驗能提供各位臨床醫師參考。

The use of a visual 4-point scoring scale improves the yield of 18F-FDG PET-CT imaging in the diagnosis of renal and hepatic cyst infection in patients with autosomal dominant polycystic kidney disease.

[18F]FDG PET/CT (PET/CT) proved useful in the diagnosis of renal and hepatic cyst infection (CyI) in patients with autosomal dominant polycystic kidney disease (ADPKD). However, the definition of CyI by PET/CT is unclear. Here, we characterize the [18F]FDG uptake in CyI in order to infer a visual 4-point diagnostic scale. All ADPKD patients hospitalized between 2007 and 2019 for suspected CyI and who underwent an [18F]FDG PET/CT scan were listed. CyI was defined by 5 concomitant criteria: fever ≥ 38 °C; abdominal pain; peak plasma CRP ≥ 70 mg/L; no other cause of inflammation; and favorable outcomes after antibiotics for ≥ 21 days. First, all PET/CT images were visually interpreted. Next, the [18F]FDG uptake around the suspected CyI was scored using a semiquantitative 4-point scale in comparison to blood and liver activities. Sixty [18F]FDG PET/CT scans were performed for suspected CyI in 38 ADPKD patients. Twenty-nine episodes met the gold-standard criteria for CyI. The visual assessment of PET/CT images reached a sensitivity of 73.1% and a specificity of 70.6%. Using the 4-point scale, an [18F]FDG score ≥ 3 (i.e., cyst uptake > liver) improved the specificity to 85.3%. [18F]FDG PET-CT is helpful in CyI diagnosis in ADPKD, and the use of a 4-point scoring of [18F]FDG uptake improves its diagnostic yield, with positive and negative predictive values of 78.3 and 78.4%, respectively. External validation is required.

Efficacy and safety of selective decontamination of the digestive tract (SDD) to prevent recurrent hepatic cyst infections in polycystic liver disease: a retrospective case series.

BackgroundHepatic cyst infection is a complication of polycystic liver disease (PLD) that causes substantial morbidity. Repetitive infection is frequent and is increasingly difficult to treat. As translocated gut bacteria are considered the cause, we hypothesize that selective decontamination of the digestive tract (SDD) reduces recurrence of hepatic cyst infection.MethodsWe performed a retrospective, observational study in two referral centres. All patients with PLD treated with SDD for hepatic cyst infection were included. Efficacy was determined by calculating the infection incidence (hepatic cyst infections per month) before and during SDD therapy. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE).ResultsWe identified eight patients who received SDD (88% female, 88% polycystic kidney disease). The median age was 65 years (IQR: 51–74 years). SDD lowered the median incidence from 0.09 episodes per month (IQR: 0.06–0.25 episodes per month) to 0.01 episodes per month (IQR: 0.00–0.05 episodes per month) (P = 0.12). Discontinuation of SDD led to rapid recurrence of cyst infection (71% within 6 weeks). SDD consisted of polymyxins with/without aminoglycosides. The median SDD treatment duration was 20 months (range: 3–89 months). Six patients (75%) developed adverse events [CTCAE Grade 1 (gastrointestinal: n = 3) or Grade 3 (ototoxicity: n = 1; fungal infection: n = 1)], mostly attributable to aminoglycosides; one patient developed polymyxin E resistance.ConclusionsSDD prophylaxis provides a novel strategy for limiting recurrent hepatic cyst infection in PLD patients. However, adverse events are frequent and curtail its use. As most were attributable to aminoglycosides, polymyxin E is considered the preferred therapy.

Pancreatic cancer with hepatic cyst infection treated with EUS-guided cyst drainage: A case report

Pancreatic cancer with hepatic cyst infection treated with EUS-guided cyst drainage: A case report

Helicobacter cinaedi Hepatic Cyst Infection with Bacteremia

Helicobacter cinaedi is an enterohepatic bacillus that causes infections of various manifestations. We report a novel case of hepatic cyst infection with bacteremia caused by H. cinaedi in an immunocompetent woman in Japan. Further research is warranted to identify the epidemiologic and clinical features of H. cinaedi infection.

Hepatic cyst infection as a source of sepsis in liver polycystosis

Hepatic cyst infection as a source of sepsis in liver polycystosis

Deep Vein Thrombosis Due to Compression of Huge Hepatic Cyst Successfully Treated by Inferior Vena Cava Filter and Cyst Drainage

An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.

Standardised Outcomes in Nephrology\u2014Polycystic Kidney Disease (SONG-PKD): study protocol for establishing a core outcome set in polycystic kidney disease

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is the most common potentially life threatening inherited kidney disease and is responsible for 5–10% of cases of end-stage kidney disease (ESKD). Cystic kidneys may enlarge up to 20 times the weight of a normal kidney due to the growth of renal cysts, and patients with ADPKD have an increased risk of morbidity, premature mortality, and other life-time complications including renal and hepatic cyst and urinary tract infection, intracranial aneurysm, diverticulosis, and kidney pain which impair quality of life. Despite some therapeutic advances and the growing number of clinical trials in ADPKD, the outcomes that are relevant to patients and clinicians, such as symptoms and quality of life, are infrequently and inconsistently reported. This potentially limits the contribution of trials to inform evidence-based decision-making. The Standardised Outcomes in Nephrology—Polycystic Kidney Disease (SONG-PKD) project aims to establish a consensus-based set of core outcomes for trials in PKD (with an initial focus on ADPKD but inclusive of all stages) that patients and health professionals identify as critically important.MethodsThe five phases of SONG-PKD are: a systematic review to identify outcomes that have been reported in existing PKD trials; focus groups with nominal group technique with patients and caregivers to identify, rank, and describe reasons for their choices; qualitative stakeholder interviews with health professionals to elicit individual values and perspectives on outcomes for trials involving patients with PKD; an international three-round Delphi survey with all stakeholder groups (including patients, caregivers, healthcare providers, policy makers, researchers, and industry) to gain consensus on critically important core outcome domains; and a consensus workshop to review and establish a set of core outcome domains and measures for trials in PKD.DiscussionThe SONG-PKD core outcome set is aimed at improving the consistency and completeness of outcome reporting across ADPKD trials, leading to improvements in the reliability and relevance of trial-based evidence to inform decisions about treatment and ultimately improve the care and outcomes for people with ADPKD.

Infected hepatic cyst: an unusual differential diagnosis of peptic perforation

Perforated peptic ulcer has many presentations with most cases presenting with pneumoperitoneum and signs of peritonitis. Here we report a case where preoperative evaluation suggested the presence of cyst associated with liver which intraoperatively revealed localized abscess secondary to peptic perforation. A 40 year old male patient presented with a tender lump confined to epigastrium and right hypochondrium, episodic vomiting, intermittent fever along with yellowish discoloration of sclera and urine for 10 days. CECT abdomen showed cystic lesion in left lobe of liver communicating with a loculated cavity which was present in association with right lobe of liver. Among the various diagnoses suggested was an infected hepatic cyst or liver abscess. During surgery there was a cystic collection of about 2 liters of pus between under surface of liver and stomach forming a pseudocyst. After draining the cavity two pinpoint perforations were found on the first part of duodenum. Omental patch repair of the perforation was done after freshening of margins with an uneventful postoperative period. CT scanning with oral contrast is the most valuable imaging technique for making an immediate and correct diagnosis of GI tract perforation especially in cases with negative X-ray and USG. On CECT abdomen hepatic cyst has sharply demarcated wall and is non-enhancing while liver abscess shows well demarcated hypodense areas with peripheral enhancement which may contain gas. The findings of the case show that although peptic perforation in itself is very common but it can have such a peculiar presentation.

International Multi-Specialty Delphi Survey: Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection

Background: Cyst infection is one of the complications of autosomal dominant polycystic kidney disease and polycystic liver disease. The diagnosis is typically made on a mix of clinical, laboratory and imaging abnormalities but the importance of individual items is uncertain. We aimed to perform a Delphi survey amongst physicians to achieve consensus on diagnostic criteria. Methods: We retrieved diagnostic items from the literature and conducted physician and patient interviews. All items were combined to create the online questionnaire. Participants rated each item during 3 consecutive rounds. Items were rated for diagnostic helpfulness for hepatic and renal cyst infection on a 9-point scale with anchors, from extremely unimportant (n = 1) to extremely important (n = 9). We determined consensus with the disagreement index. The median rating of each item was calculated and categorized into inappropriate (≤3.4), uncertain (3.5-6.4) or appropriate (≥6.5). By combining all items that reached an appropriate consensus rating, we developed a diagnostic algorithm based on expert consensus. Results: We invited 58 physicians to participate in the survey. In total, 35 (60%) responded to round 1 of which 91% (n = 32) and 86% (n = 30) responded to round 2 and 3, respectively. The final panel included 23 nephrologists, 5 hepatologists, a nuclear medicine specialist and an infectious disease physician from 11 countries (male 67%, mean age 47 ± 11 years, median clinical experience 21 years). The panel rated the diagnostic helpfulness of 59 potential items. Ultimately, 22 hepatic and 26 renal items were rated appropriate, including positive blood cultures and fluorodeoxyglucose positron-emission CT imaging. Ultrasonography and absence of intracystic bleeding were amongst those deemed uncertain or inappropriate. Subsequently, by combining items rated appropriate, we developed a clinical tool to diagnose hepatic and renal cyst infection. Conclusions: We identified diagnostic items for hepatic and renal cyst infection and developed an expert-based diagnostic algorithm, which may aid physicians in the diagnostic work-up. A prospective study is necessary to validate this algorithm.

Surgical Management of Calcified Liver Hydatid Cyst Complicated with Thoracobiliary Fistula: A Case Series and Literature Review

Thoracobiliary fistula is a rare complication of hydatid cyst of the liver especially in the calcified form. Surgery is the only medical option. The treatment consists of radical surgical procedures in the majority of the patients. Conservative surgical treatments are performed with high mortality rate. Herein, we will describe two patients of calcified hydatid cysts of the liver whose condition becomes complicated with Thoracobiliary fistula. The first patient was treated with right thoracotomy and resection of pleural hydatid cysts. Then, were evacuated the ruptured laminated membrane and daughter cysts of infected hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified liver hydatid cyst. The second patient was also treated with right thoracotomy, resection of pulmonary hydatid cysts, evacuation of ruptured bile stained laminated membrane and daughter cysts of hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified cyst cavity. Our patients underwent conservative surgery which posed a severe risk. Both cases are discussed together with review of the literature.

遷延性肝囊胞感染を有する常染色体優性多発囊胞腎 (ADPKD) に対する生体腎移植の1例

遷延性肝囊胞感染を有する常染色体優性多発囊胞腎 (ADPKD) に対する生体腎移植の1例

Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics

Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD). Lipid-soluble antibiotics like fluoroquinolones show good penetration into cysts and are recommended for cyst infection, but causative microorganisms are often resistant to these agents. This study investigated the profile of the microorganisms causing cyst infection in ADPKD, their susceptibility to lipid-soluble antibiotics, and clinical outcomes. This retrospective study reviewed all ADPKD patients admitted to Toranomon Hospital with a diagnosis of cyst infection from January 2004 to March 2014. All patients who underwent cyst drainage and had positive cyst fluid cultures were enrolled. Patients with positive blood cultures who satisfied our criteria for cyst infection or probable infection were also enrolled. There were 99 episodes with positive cyst fluid cultures and 93 episodes with positive blood cultures. The majority of patients were on dialysis. The death rate was high when infection was caused by multiple microorganisms or when there were multiple infected cysts. Gram-negative bacteria accounted for 74-79% of the isolates in all groups, except for patients with positive hepatic cyst fluid cultures. The susceptibility of Escherichia coli to fluoroquinolones was very low in patients with hepatic cyst infection, especially those with frequent episodes and those with hepatomegaly. Fungi were detected in two episodes. Fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. It is important to identify causative microorganisms to avoid the overuse of fluoroquinolones and to improve the outcome of cyst infection in ADPKD.