Right Lobe Of Liver Research Articles

The Classification of Biliary Strictures in Patients With Right-Lobe Liver Transplant Recipients and Its Relation to Traversing the Stricture With a Guidewire.

Traversing the stricture with a guidewire is a prerequisite for the endoscopic treatment of biliary strictures after living donor liver transplantation. We aimed to evaluate the effect of variations in the biliary anastomosis and strictures on the success of endoscopic treatment and suggest a cholangiographic classification. The 125 strictures among the 104 patients with right-lobe living donor liver transplantation were reviewed. The strictures were classified by the anastomosis pattern according to the number (1, 2, or >2), location (common bile, hepatic, or cystic duct), the angle between the proximal and distal sites of the anastomosis, and the contrast enhancement pattern. The relationship between the success rate of traversing the anastomosis and the classification was evaluated. Of the 125 biliary strictures, 86 (68.8%) could be passed via endoscopically. Thirty-three strictures were managed either percutaneously (n = 13) or by magnetic compression anastomosis (n = 20). Compared with the round, the triangular (odds ratio [OR], 6.5), the intermediate form (OR, 17.7), and the end-to-side anastomosis (OR, 5.1) were associated with an increased chance of traversing. The contrast enhancement pattern of the strictures and the bile ducts was also related to the successful rate of the endoscopic treatment (P < 0.001). The success rate was higher in the patients with the angle between the proximal and distal sites of the anastomosis approximated was small (0°-30° = 74%, 30°-60° = 69%, 60°-90° = 63%, >90° = 41%). The type of biliary anastomoses and stricture affect the success rate of endoscopic treatment. These data may play role in making decision about the type of anastomosis during the surgery.

Step 1: the puncture path between the right lobe of liver and the gallbladder is evaluated by CEUS and no large vessels can be seen

Step 1: the puncture path between the right lobe of liver and the gallbladder is evaluated by CEUS and no large vessels can be seen

A Rare Case Report of Hypoplasia of Liver Lobe with Ectopia of Gall Bladder- Is Small Liver Lobe Always Pathological?

Hypoplasia of right lobe of the liver with secondary ectopia of gall bladder is one of the rare morphological developmental anomalies of liver. Frequently, it is also associated with other hepatobiliary anomalies. Patients with such anomalies are more prone to surgical complications due to altered anatomical positions and are also at risk to develop cholecystitis, gall stones, and portal hypertension. The knowledge of such liver anomalies is important for radiologists to avoid surgical and medical pitfalls. Here, the authors report a rare case of hypoplasia of right lobe of liver in a 74-year-old female patient who had no clinical features of liver or biliary disease and with normal liver function test. It was incidentally detected in her Computed Tomography (CT) pulmonary angiogram and further confirmed in Ultrasound (US) and Magnetic Resonance Imaging (MRI)

Bleeding with in a Huge Angiomyolypoma of Liver Presenting as an Acute Abdomen

Epithelioid angiomyolipoma (EAML) of liver is a rare neoplasm. It is even rare to present as an acute abdomen. It is usually misdiagnosed as other neoplasms such as hepatocellular carcinoma due to non-specific clinical and radiologic features. Most tumors are small and asymptomatic but few of them can be large in which case there is a possibility of hemorrhage into the tumor. Here, we report a case of 19-year-old girl who presented with an acute abdominal pain and 8 cm mass was found on the right lobe of liver with bleeding with in the tumor.

Klebsiella pneumoniaeによる肝膿瘍から敗血症性ショックに至り高病原性K. pneumoniae感染症が疑われた大酒家の1例(A case of a heavy drinker with septic shock due to liver abscess caused by Klebsiella pneumoniae)

要旨高血圧症以外は既往なくADLの自立した77歳の男性。搬送当日，朝まで通常通りの生活をしていたが，同日夕刻にトイレ内で転倒し呼吸苦を訴えた。救急隊接触時から当院搬送までにショックバイタルとなり人工呼吸器や昇圧剤を使用して全身治療を開始した。精査の結果肝膿瘍による敗血症性ショックと診断し抗菌薬治療と速やかな肝膿瘍ドレナージを施行した。膿瘍培養と血液培養からはKlebsiella pneumoniae（K. pneumoniae）が検出され，血液寒天培地のコロニーからのstring testが陽性となりhypermucoviscosity phenotypeのK. pneumoniaeによる肝膿瘍と判断し，高病原性K. pneumoniae感染症（hypervirulent K. pneumoniae: hvKp）として全身検索を含めた対応をとった。基礎疾患のない患者が急性経過でショック状態になる疾患として，近年アジアや本邦で報告が増えるhvKp感染症を鑑別に挙げる必要があると考えられ，当院で経験した症例を報告する。

Tuberculosis presenting as a liver mass in a pregnant lady.

A 20-year-old primigravida (19 weeks of gestation) presented with dull pain in the right upper quadrant for 2 weeks. She had no history of jaundice, features of hepatic decompensation, constitutional symptoms or use of oral contraceptives. An ultrasound examination revealed a heteroechoic, solid mass in the right lobe of liver (7cm x 8cm) without any evidence of cirrhosis. Liver function tests were normal, and tests for hepatitis B, hepatitis C and HIV were non-reactive. Serum alpha-fetoprotein was 99 ng/ml (<55 ng/ml at 19 weeks of gestation).

Amoebic liver abscess with lung involvement in paediatric

Background: There are few reports of amoebic liver abscess in children, and the disease is life-threatening. It can rupture into the pleura to cause acute respiratory distress. Pulmonary amoebiasis, the second most common extra-intestinal pattern of infection, is frequently associated with amoebic liver abscesses. Case Description: We reported a case of amoebic liver abscess with lung involvement in a 10 y old Malaysian boy who presented with prolonged fever, lethargy, diarrhea, and right hypochondriac pain. He was diagnosed with possible ruptured liver abscess. Intravenous Ceftriaxone and Metronidazole were commenced. No organism was isolated in Blood culture, and stool microscopic examination for ova and cyst was negative. Ultrasonography of abdomen revealed of peritoneal collection with amoebic liver abscess in the superolateral segment of right lobe of liver whereas ultrasonography of thoracic showed pleural effusion and collapsed consolidation of right lower lobe of lung. After two days of admission, he developed acute respiratory distress Abdominal and chest drainage were done. Pleural fluid microscopic examination revealed Trophozoite of Entamoeba histolytica. Patient responded well clinically after completed four ws of treatment of Metronidazole. Discussion: The role of microscopic stool examination is limited. In this case, only one sample of stool was sent, and a microscopic stool examination of the cyst was negative. In view of the difficulty in demonstrating the causative pathogen in a clinical specimen, serological methods play an important role in diagnosing amoebic liver abscess. If the patient had undergone drainage of the abscess surgically, the aspiration material could be sent for microscopic examination. In this case, the microscopic examination of pleural fluid revealed the trophozoite of Entamoeba histolytica. Ultrasonography is easy and very useful in making early diagnosis and treatment. Most uncomplicated amoebic liver abscesses can be treated successfully with amoebicidal drug therapy alone. However, such in this case, ruptured amoebic liver abscess with lung involvement, surgical drainage is needed. In this case, the patient was responded well after four ws of treatment of Metronidazole. Conclusion: A multidisciplinary approach, including a gastroenterologist, radiologist, surgeon, and laboratory, is crucial for early diagnosis and successful treatment of these curable infections to prevent further complications, which can compromise the patient's outcome.

Hepatoblastoma With Rubinstein-Taybi Syndrome: A Rare Association

Abstract Introduction/Objective Hepatoblastoma is a malignant neoplasm of liver, exclusively seen in pediatric population. It has been known to occur with various syndromes like Li-fraumeni, Beckwith-Wiedemann, and Simpson-Golabi- Behmel among others. Small undifferentiated cells and macro-trabecular pattern with increased mitotic activity and AFP&amp;gt;100 are associated with unfavorable prognosis. Rubinstein-Taybi syndrome is a rare genetic disease. Even though there has been intensive research on the genetic and epigenetic function of the CREBBP and EP300 genes in animal models, the etiology of this rare and devastating syndrome is largely unknown. Hepatoblastoma with Rubinstein-Taybi syndrome is an extremely rare occurrence. Methods Here we present an incidental case of Hepatoblastoma with Rubinstein-Taybi syndrome Results A 17-month-old Caucasian female with Rubinstein-Taybi syndrome, was found to have an incidental 1.1 cm nodule in the right lobe of liver. Her AFP was elevated (244.9ng/ml). Hepatic resection revealed a well-circumscribed tan white mass, measuring 3.5 cm in the greatest dimension. On microscopy, uniform round to cuboidal cells resembling fetal hepatocytes, with finely granular cytoplasm, small round nuclei, and indistinct nucleoli were seen. The cells were arranged in solid sheets and scant trabecular arrangement separated by narrow sinusoids. The tumor displayed predominantly fetal histology, with rare embryonal and small undifferentiated cell nests. The diagnosis of Hepatoblastoma was made. The patient underwent chemotherapy and was doing well at 5-years follow-up. Conclusion Extensive screening of patients in recent times has revealed mutations in CREBBP and EP300 in only around 50% of cases. The genetic and epigenetic associations of the syndrome in the remaining half of cases remains to be identified. Hepatoblastoma with Rubinstein-Taybi Syndrome is an extremely rare occurrence and might shed some light on other genes that could be involved in this syndrome. Further studies to review the mutation spectrum to understand the causative molecular mechanisms are deemed essential.

S1466 Blood Is Thicker Than Water...and Bile: A Rare Case of Hemobilia

INTRODUCTION: There are a myriad of etiologies concerning upper gastrointestinal bleeding (UGIB). The common culprits include peptic ulcer disease, erosive esophagitis, and varices. However, if we delve deeper into literature, way deeper, we find a more elusive source for the ever-so common UGIB: hemobilia. Hemobilia is bleeding arising from the biliary tract. Over 50% of cases are secondary to iatrogenic causes. This can be attributed to the prevalence of interventional procedures. Here, we present a 65-year-old male with a recently diagnosed history of hepatocellular carcinoma (HCC), who presented with a sudden elevation in liver enzymes and bilirubin, and subsequently was found to have hemobilia. CASE DESCRIPTION/METHODS: Our patient is a 65-year old male with past medical history significant for decompensated cirrhosis of unknown etiology and HCC who presented to the emergency room for a CHF exacerbation. Two days into his hospital stay, our patient's lab work revealed acute transaminitis and hyperbilirubinemia. A subsequent magnetic resonance cholangiopancreatography (MRCP) was performed which showed a questionable filling defect in the mid common bile duct (CBD), unchanged mass in the right lobe of liver, and a filling defect seen within the portal vein concerning for tumor thrombus. Total bilirubin peaked at 13.1 mg/dL. ERCP was performed with balloon sweep of the CBD and removal of large amount of blood clots indicating hemobilia. One 10 mm diameter covered metal stent was placed into the CBD. It was determined that the most likely etiology of the hemobilia was tumor invasion of the biliary tree producing a spontaneous hemorrhage. DISCUSSION: “En garde!” Imagination dictates that this French phrase meaning “On your guard!” could have been associated with the first case of hemobilia. Hemobilia was first described in 1654 by Francis Glisson when he described a liver laceration a man received during a duel. Hemobilia is usually described by Quincke's triad of upper abdominal pain, jaundice, and UGIB. However, this classic presentation is only observed in approximately 35% of cases. Our patient, with a known history of HCC, initially did not present with any of these symptoms-the only alarm finding was sudden transaminitis. As stated earlier, it is iatrogenic causes that predominantly lead to hemobilia. On the other hand, the most common cause of spontaneous hemobilia is hepatobiliary malignancy. HCC is the most common malignancy associated with hemobilia, with cholangiocarcinoma being a close second.Figure 1.: Shows hemobilia prior to intervention.Figure 2.: Shows large blood clot being swept out of CBD.Figure 3.: Shows blood and bile flowing through covered metal stent.

Preliminary Clinical Experience with Shear Wave Dispersion Imaging for Liver Viscosity in Preoperative Diagnosis of Focal Liver Lesions.

The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21-74 years, 37males) with 58 FLLs located on the right lobe of liver were prospectively studied. The Aplio i900 series diagnostic ultrasound system (Canon Medical systems) equipped with a curvilinear PV1-475BX transducer (1-8 MHz) was used. SWD slope and viscosity measurements were expressed as mean ± standard deviation for both liver tumors and background liver parenchyma. Histopathological results after surgery were regarded as the gold standard for diagnosis. Final diagnosis included 40 cases of malignant and 18 cases of benign FLLs. The mean viscosity value were 14.78 ± 1.86 m/s/kHz for hepatocellular carcinoma (n = 30), 14.81 ± 2.35 m/s/kHz for liver metastasis lesions (n = 10), 13.23 ± 1.31 m/s/kHz for hemangioma (n = 13), and 13.67 ± 2.72 m/s/kHz for focal nodular hyperplasia (n = 5). Malignant FLLs showed higher mean viscosity values (14.79 ± 3.15 m/s/KHz) than benign FLLs (13.36 ± 2.76 m/s/KHz) (p < 0.05). The best performing cut-off value of lesion viscosity was 13.15 m/s/kHz (sensitivity 83.3 %; specificity 56.5 %; area under the curve (AUC) 0.71) for malignancy) (p < 0.05). The analysis of SWD slope and liver viscosity parameters provide additional viscoelastic information about FLLs before operation.

Hepatic adrenal adenoma-rare tumor on right lobe of liver: a case report and literature review

BackgroundHepatic adrenal ectopia is a common clinical diagnosis, whereas adrenal tumors developed from hepatic adrenal ectopia are rare. Hepatic adrenal tumors are easily misdiagnosed as hepatic carcinoma and frequently treated by unnecessary operations.Case presentationA 50-year-old female patient was hospitalized due to B-ultrasonic detection of “right focal liver lesions.” After hospitalization, enhanced CT examination was performed. A 2.2 cm × 1.8 cm tumor was found in the seventh section of the right liver, as indicated by obvious enhancement of the arterial phase and low density during the portal vein and delay stages. Enhanced MRI examination detected a 2.0 cm × 1.8 cm tumor on the right liver, which was considered a “primary hepatic carcinoma”. The patient was treated by open hepatectomy and recovered well after the operation. The postoperative pathological diagnosis was hepatic adrenal adenoma. No relapse was observed through the 1-year follow-up visit.ConclusionsAccording to imaging manifestations, pathological immunohistochemical treatment, alpha fetoprotein (AFP) and clinical features, hepatic adrenal tumors should be considered in the diagnosis of hepatic carcinoma to prevent misdiagnosis. Hepatic adrenal tumors should be ruled out during the diagnosis to avoid unnecessary operation.

Mucinous Cystadenoma of Liver with Mesenchymal Stroma

Hepatobiliary cystadenoma is a rare benign cystic tumor of the liver. These are predominantly located in right hepatic lobe. A 45 year old female presented with abdominal pain, epigastric discomfort, fever and vomiting. On radiological evaluation USG showed large multiloculated cystic mass in right lobe of liver. Contrast Enhanced CT examination exhibited exophytically growing multiloculated cytic lesion with differential content and peripheral capsular and central enhancement with imaging diagnosis of hydatid cyst was given. The surgical excision of hepatic cyst was done. On histopathology reported as mucinous cystadenoma of liver with mesenchymal stroma. We are presenting this case for its rarity, clinical, radiological and histopathological findings.

PLEURAL EFFUSION CAUSED BY KLEBSIELLA PYOGENIC LIVER ABSCESS

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Historically, pyogenic liver abscesses were most commonly of Escherichia coli or polymicrobial etiology. Klebsiella pneumoniae has become a rising cause of pyogenic liver abscesses, particularly in Taiwan, since 1996 [1]. Predisposing factors of Klebsiella primary liver abscess (KLA) include diabetes, prior antibiotic use, and specific virulence factors including the K1 capsular antigen genotype[2]. This case details a middle-aged, non diabetic, male who presented with KLA that resulted in metastatic pleural empyema after abscess drainage. CASE PRESENTATION: A 52 year old male without medical history, presented with sharp, right upper quadrant moderate abdominal with radiation to the back for three months. He had mild guarding with active bowel. One month prior, he had a computed tomography (CT) of the abdomen showed cholecystectomy and a complex fluid collection posterior to the right hepatic lobe that measured 3.0 x 2.5 cm. A repeated CT upon this admission revealed a 5 x 3.1 x 4.8 cm heterogeneous collection along the posterior aspect of the right lobe of liver. The fluid collection was increased in size compared to prior imaging and concerning for an abscess. The patient underwent CT-guided abscess drainage with a drain placement five days after admission. Antibiotic treatment with Zosyn was initiated; the patient also received Flagyl and vancomycin. The culture of the abscess grew K. pneumoniae. Shortly following the abscess drainage, the patient began exhibiting shortness of breath with decreased breath sounds, dyspnea with activity, ongoing low grade fever, and leukocytosis. At the day of the drainage, his white blood cell count (WBC)15,800. CT-guided pleural fluid drainage with pigtail chest tube placement done. Pleural fluid analysis showed a lactate dehydrogenase(LDH) of 2,628 and a total protein (TP) of 4.7 consistent with exudate, and a pH of 7. The culture of the pleural fluid also grew K. pneumoniae. Infectious disease recommendation to continue the course of Zosyn for a total of four weeks from the day of the abscess drain placement. A repeated CXR reported slight improvement of the right pleural effusion with symptomatic improvement with chest tube placement and significant drainage of pleural fluid. The patient was seen as an outpatient with significant improvement. DISCUSSION: The clinical significance of the increasing trend of KLA should be noted due to potential metastasis, most commonly endophthalmitis and meningitis, which occur more frequently than in other microbial etiologies of liver abscesses. In a 1998 study done in Taiwan 11.9% of KLA resulted in metastatic complications compared to 0% of polymicrobial liver abscesses [2]. Furthermore, the significant risk factor of diabetes mellitus as a predisposing factor. CONCLUSIONS: To keep in our mind that pleural empyema due to Klebsiella Pneumoniae can be a consequnt complication of liver abscess. Reference #1: 1. Yang CC, Yen CH, Ho MW, & Wang JH (2004). Comparison of pyogenic liver abscess caused by non-Klebsiella pneumoniae and Klebsiella pneumoniae. J Microbiol Immunol Infect., 37(3), 176. Reference #2: 2. Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, Wann SR, & Lin HH (1998). Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis., 26(6), 1434. DISCLOSURES: No relevant relationships by WAQAS HAFEEZ, source=Web Response No relevant relationships by Nooraldin Merza, source=Web Response No relevant relationships by Mazin Saadaldin, source=Web Response

2248 Primary Malignant Mesothelioma of Liver: A Rare Liver Tumor

INTRODUCTION: Primary malignant mesothelioma of liver is an extremely rare condition. Less than twenty cases have been reported so far in literature. This presents as liver mass and differentials include primary and secondary tumors of the liver. We describe the case of a 70-year-old male with asbestos exposure who was incidentally found to have primary malignant mesothelioma of liver in screening CT scan. CASE DESCRIPTION/METHODS: A 70-year-old non-smoker, nonalcoholic male with past medical history of pulmonary asbestosis (had a stable calcified pleural plaques, no evidence of metastatic disease in the chest) being followed with annual low dose CT scan for asbestosis exposure management was found to have an incidental liver mass in the CT scan. He did not have icterus, itching of the skin or change in his stool color or weight loss. Upon examination, he was found to be hemodynamically stable, there was no jaundice. There was no right upper quadrant tenderness on palpation. CT scan of abdomen with contrast was obtained that showed an 8 cm mass involving the right lobe of liver predominantly the segment 6 (Figure 1). This mass was highly concerning for liver malignancy. A bone scan was obtained for metastatic workup which did not reveal any metastatic disease. CT scan of the chest was done that did not show any evidence of hematogenous metastasis or mesothelioma in the thorax. His hepatitis panel, AFP level were negative. There was no elevation of liver enzymes. The patient underwent partial hepatectomy (segments V/VI), diaphragm resection and cholecystectomy. Biopsy of the liver mass showed a poorly differentiated malignancy, showing areas of epitheloid and spindle cell morphology. The tumor cells were positive for keratin AE1/AE3, keratin CAM 5.2, WT1, calretinin, CK20 and D2-40. Tumor cells were negative for arginase, CK 5/6, ERG, mucicarmine, MOC 31, BerEp4, desmin, S–100, and albumin in situ hybridization. The overall morphology as well as immunohistochemical staining pattern were most consistent with malignant mesothelioma. The patient was started on adjuvant chemotherapy with Pemetrexed and Cisplatin. DISCUSSION: Primary malignant mesothelioma of liver is an extremely rare condition. This presents a solitary lesion in the liver. Treatment includes surgical resection followed by adjuvant chemotherapy with Pemetrexed and Cisplatin. It should be considered as a differential in patients with solitary liver mass.

Utility of Polyethylene Terephthalate (Dacron) Vascular Grafts for Venous Outflow Reconstruction in Living-Donor Liver Transplantations

BackgroundVenous outflow reconstruction of modified right-lobe liver grafts has been shown to prevent the occurrence of graft congestion and subsequent complications, including graft loss. In the present study, we aimed to investigate the safety and efficacy of Dacron grafts for venous reconstruction in living donor liver transplantation (LDLT). MethodsBetween January 2016 and January 2018, Dacron grafts were used in 148 liver transplants. Of these, 104 patients who had a follow-up computerized tomography (CT) scan were enrolled into the study. A total of 179 outflow hepatic veins including V5, V8, partial middle hepatic vein, and accessory inferior right hepatic veins (IRHV) were reconstructed using synthetic Dacron grafts. Graft patency was evaluated with both intraoperative Doppler ultrasonography following reconstruction, and a follow-up CT was performed on the postoperative day 7 (±1). Retrospective data collection included demographics, parameters for small-for-size (laboratory tests [bilirubin, International Normalized Ratio] and ascites) syndrome, postoperative morbidity, and mortality. ResultsFollow-up CT revealed graft patency in 155 out of 179 (86.6%) vascular grafts. Postoperative seventh-day patency rates for each reconstructed vein were as follows: V5, 87.5% (70/80); V8, 87.7% (50/57); partial middle hepatic vein, 100% (11/11); and IRHV, 77.4% (24/31). No major graft-related complications (early graft dysfunction, graft infection) or graft-related mortality were observed. None of the recipients developed small-for-size syndrome based on laboratory tests and clinical findings. ConclusionsDacron vascular grafts appear as an advantageous and useful alternative for venous outflow reconstruction in LDLT.

A Rare Case of Pulmonary Embolism: A Case Report

Pulmonary embolism in an old patient with a history of coagulation disorder, any recent major surgeries or in a chronic heart or lung diseases is widely reported. Also, a recent history of travel by air with flight distance of more than 5000km or BMI greater than 35 kg/m2 increase risk. However, we report here, a suggestive case of acute pulmonary embolism in a previously well male of 38 years, with a BMI of 25.71kg/m2 without any history of chronic illness or acute exacerbations.&#x0D; The patient presented in health facility with sudden onset of radiating chest pain and some other nonspecific symptoms. Neither any other significant personal risk factors except smoking, nor any family history of heart/lung diseases were ruled out during initial assessments. On investigations, other routine examinations were normal but T-wave inversion was noticed in lead V1-4 in ECG, Troponin-I was positive and CPK-MB was slightly elevated (27 U/L). Furthermore, no any remarkable changes were noticed in Chest X-ray. Then, the patient was referred to higher center with cardiac facility with provisional diagnosis of Acute Coronary Syndrome for further evaluation and management.&#x0D; Thereupon, Coronary Angiogram (CAG) was done and the report was normal but echocardiography findings were suggestive of pulmonary Embolism. D-dimer was also elevated (8279.05 ng/ml) but venous doppler study of bilateral lower limb was normal. Finally, CT-PA showed partially occluding thrombus in main pulmonary bifurcation extending into left and right pulmonary artery, its bilateral segmental branches and calcified granuloma was seen in right lobe of liver. Patient was under inj. LMWH and other supportive management during hospitalization. After an uneventful hospital stay for 12 days, general condition was improved and eventually, patient was discharged, with oral warfarin.&#x0D; Keywords: chest pain; Nepal; pulmonary embolism; risk factors.

Variability and Reliability of Normal Liver 18F-FDG Standardized Uptake Value in Relation to Placement of Volume of Interest

Background: The impact of volume-of-interest (VOI) placement on liver standardized-uptake-value (SUV) measurement remains unclear. Objectives: To investigate variability and reliability of liver SUV in relation to placement of VOI within the right lobe of the liver. Patients and Methods: Positron emission tomography-computed tomography (PET/CT) of 343 patients with normal liver were retrieved. Liver mean SUV (SUVmean) were measured by placing spherical VOIs at upper, portal vein and lower level of the right-lobe liver. The general linear model, Bland-Altman analysis, one-way ANOVA were performed and the intraclass correlation coefficients (ICC) were calculated to identify impacts of reader and VOI position on variations of liver SUVmean. Results: The liver SUVmean at the upper, lower and portal vein level were 1.85 ± 0.435, 1.88 ± 0.409, and 1.89 ± 0.414, respectively, with no significant inter-location difference (P = 0.449). The coefficients of variation were close among locations (21.9% - 23.5%). The inter-location ICCs controlling for reader were 0.955 for reader 1 and 0.980 for reader 2, while the inter-reader ICCs controlling for location were between 0.930 and 0.937, indicating great reliability and reproducibility. However, inter-reader bias of SUVmean were significantly different among locations (P < 0.001). Bias at portal vein level (0.069 ± 0.112) was significantly larger than those at the upper level (0.004 ± 0.144, P < 0.001) and lower level (0.002 ± 0.136, P < 0.001). Conclusion: Liver SUVmean measured by placing VOI at the portal vein level exhibited a relatively larger variation and less precision between readers, which was not recommended.

Safety and efficacy of ultrasound guided percutaneous needle aspiration of liver abscess

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical country. Traditionally for many years they were treated with antimicrobial alone, blind percutaneous aspiration or surgical exploration. This conception gradually changes into guided percutaneous aspiration or drainage with development of advanced diagnostic imaging modality.&#x0D; Objectives: To evaluate the safety and efficacy of management of liver abscess by Ultrasound (US) guided percutaneous needle aspiration.&#x0D; Methods: From August 2009 to July 2018 a total 380 patients with liver abscess were referred to the department of radiology and imaging for US guided percutancous aspiration. All patients were evaluated clinically and by USG. Aspiration of the abscess was carried out under strict aseptic precaution.&#x0D; Results: A total of 380 patients with liver abscess were successfully treated, consisting of 338 males and 42 females, male female ratio 8:1. The age ranges from 11 to 80 years. Majority (78%) had single abscess and 22% had two or more. Most of the abscess are located in the right lobe of liver (79%). Single needle aspiration were needed in 30% of patient, second aspiration were needed in 38% of patients and third aspiration in 32% of patients. Average aspiration per patient was 2.02. The amount of aspirated pus ranged from 250 to 2450 ml.&#x0D; Conclusion: Ultrasound guided percutaneous needle aspiration of liver abscess is a safe and successful therapeutic approach in the treatment of liver abscess whether pyogenic or amoebic.&#x0D; Bang Med J (Khulna) 2018; 51 : 3-6

A comparative study of liver abscess: therapeutic aspiration verses continuous catheter drainage

Background: Previously liver abscesses were treated primarily by surgery but with advances in imaging techniques the trend is changing towards use of potent antimicrobials and minimally invasive ultrasound guided interventional procedures and surgery is being done only in selected cases. We conducted this study to find out the feasibility, limitations, effectiveness, outcome and complications of therapeutic needle aspiration and continuous catheter drainage of liver abscess.Methods: This was a hospital based randomized control prospective study in which patients with liver abscess were included. 100 patients of liver abscess selected by simple randomization to 2 groups namely Group A (needle aspiration) or Group B (continuous catheter drainage) undergo the above two interventional procedures. For statistical purposes P value less that 0.05 was taken as statistically significant.Results: This study consisted of 100 patients out of whom there were 78 (78%) males and 22 (22%) females with a M:F ratio of 1:0.28. Single hepatic abscess (75%) was more common than multiple abscesses (25%) and pyogenic abscess (67%) was more common than amoebic abscess (33%). Right lobe of liver was most commonly involved (61%) followed by left lobe (22%). All patients in both the groups were treated successfully and there was no treatment failure in any of the groups.Conclusions: Therapeutic needle aspiration as well as continuous catheter drainage both are equally effective in management of liver abscess but needle aspiration had the advantage of being less expensive, easily available and requiring less hospital stay.

Ultrasonographic Liver Findings in a Sheep Flock Involved in Chronic Fasciolosis

Background: Fasciola hepatica is a genus of the trematodes which mainly affects the liver of sheep and these livestock are accidentally infected by eating plants or drinking water contaminated with the metacercariae of this parasite. These parasites can cause considerable economic damage by destroying the liver and bile ducts. OBJECTIVES: The aim of this study was to evaluate the role of ultrasonographic diagnosis in chronic hepatic fasciolysis of sheep and to provide ultrasonography views of fasciolosis in sheep’s liver. METHODS: In this cross-sectional study, 256 sheep of the Makoei breed, including 130 male (50.8%) and 126 female (49.2%) with diagnosis of chronic fasciolosis confirmed by the appearance of fluke eggs in feces and using enzyme-linked immunosorbent assay (ELISA) were referred to the Department of Radiology and Ultrasonography, Doppler ultrasound was performed. Average age of sheep was 2.1 years (minimum age 7 months and maximum age 6 years). Data were analyzed by SPSS software (version 11.5) and the statistical test was chi-square test. P value less than 0.05 was considered significant. RESULTS: In the results, 55.6% of sheep had ascites in the abdominal cavity and in 5.7% and 11.3%, bile ducts and gallbladder were affected, respectively, and in 4.8% of sheep both the liver and the bile ducts were involved. In 22.6% of sheep, there was no abnormal finding in ultrasound. The most common site of injury was in the posterior part of the right lobe of liver. There was no significant difference between the place of involvement in the liver, age and sex of the patients. CONCLUSIONS: According to this study, ultrasonography can play an important role in the diagnosis and follow up of sheep’s chronic fasciolosis treatment.