Imaging and Percutaneous Treatment of Secondarily Infected Hepatic Infarcts
Imaging and Percutaneous Treatment of Secondarily Infected Hepatic Infarcts
Objective: The objective of our study was to describe the imaging features and success rate of percutaneously treated infected hepatic infarctions.
Materials and Methods: Three hundred ninety-two patients had percutaneous liver abscess aspiration and drainage or aspiration and intraoperative débridement at our institution between 1990 and 2003. One hundred fifty-one of these patients underwent CT at least 2 days before the drainage procedure and immediately before the procedure. Retrospective review of the imaging and medical records identified 13 patients with microbiologically documented liver abscesses who had liver lesions consistent with hepatic infarction on the baseline CT.
Results: Twenty-one hepatic infarctions in 13 patients were documented on baseline CT, 15 of which became secondarily infected. Ten of 15 patients with infected infarctions had undergone either hepatic transplantation or the Whipple procedure. Although the left lobe was slightly more commonly infarcted than the right lobe (54% vs 46%, respectively), right lobe infarctions were more commonly superinfected than left lobe infarctions (61% vs 39%); however, neither of these distinctions was statistically significant. Twelve of 13 patients underwent percutaneous drainage. The duration of catheter drainage was significantly longer in patients in whom catheter drainage was complicated by biliary communication than those without biliary communication (61 vs 19 days, respectively). Eleven of 12 patients (92%) responded to drainage such that they survived to discharge from the hospital.
Conclusion: Patients with hepatic infarctions are at risk for secondary infection, particularly those patients having undergone surgery involving the porta hepatis. Percutaneous abscess drainage can be performed safely with excellent technical and clinical outcomes in this complex patient population.
The increased use of CT in the evaluation of the postoperative patient has led to the increased recognition of disease processes once considered rare. One such disease process is hepatic infarction. Although the liver parenchyma is partially protected from infarction because of its dual blood supply, several reports have documented the increased detection and the CT characteristics of these lesions. Hepatic infarctions appear as well-defined, hypodense, wedge-shaped, and geographic lesions extending from the hepatic hilum to the hepatic capsule. Infarctions result from hepatic hypo perfusion with or without associated vascular occlusion, either hepatic arterial or portal venous. The patient population who develop hepatic infarction has not been clearly delineated, but an association of hepatic infarction with surgery involving the porta hepatis, including hepatic transplantation and pancreaticoduodenectomy (Whipple procedure), is suspected.
The complicated postsurgical patient who develops hepatic infarction may be susceptible to additional complications, including infection. Secondary infection of infarcted parenchymal tissue may result in liquefaction and abscess formation. The imaging appearance of hepatic abscesses on CT has been well described as a lesion with a thin enhancing rim with hypoattenuating nonenhancing internal contents. Both portal venous and hepatic venous thrombosis may be associated with hepatic abscess formation. Once parti ally liquefied, infected hepatic infarctions may be suitable for percutaneous abscess drainage. Multiple studies have documented the safety and efficacy of percutaneous abscess drainage, although complications including postprocedure sepsis do occur.
Percutaneous drainage has long been the accepted primary therapy of parenchymal organ abscesses, including those of the liver, but no reports published to date describe the clinical background, imaging appearance, or outcome of patients with percutaneously drained infected hepatic infarctions. The purpose of this investigation was to describe the patient population, imaging characteristics, and success rate of percutaneously drained hepatic infarctions that have become abscesses as the result of secondary infection.
Objective: The objective of our study was to describe the imaging features and success rate of percutaneously treated infected hepatic infarctions.
Materials and Methods: Three hundred ninety-two patients had percutaneous liver abscess aspiration and drainage or aspiration and intraoperative débridement at our institution between 1990 and 2003. One hundred fifty-one of these patients underwent CT at least 2 days before the drainage procedure and immediately before the procedure. Retrospective review of the imaging and medical records identified 13 patients with microbiologically documented liver abscesses who had liver lesions consistent with hepatic infarction on the baseline CT.
Results: Twenty-one hepatic infarctions in 13 patients were documented on baseline CT, 15 of which became secondarily infected. Ten of 15 patients with infected infarctions had undergone either hepatic transplantation or the Whipple procedure. Although the left lobe was slightly more commonly infarcted than the right lobe (54% vs 46%, respectively), right lobe infarctions were more commonly superinfected than left lobe infarctions (61% vs 39%); however, neither of these distinctions was statistically significant. Twelve of 13 patients underwent percutaneous drainage. The duration of catheter drainage was significantly longer in patients in whom catheter drainage was complicated by biliary communication than those without biliary communication (61 vs 19 days, respectively). Eleven of 12 patients (92%) responded to drainage such that they survived to discharge from the hospital.
Conclusion: Patients with hepatic infarctions are at risk for secondary infection, particularly those patients having undergone surgery involving the porta hepatis. Percutaneous abscess drainage can be performed safely with excellent technical and clinical outcomes in this complex patient population.
The increased use of CT in the evaluation of the postoperative patient has led to the increased recognition of disease processes once considered rare. One such disease process is hepatic infarction. Although the liver parenchyma is partially protected from infarction because of its dual blood supply, several reports have documented the increased detection and the CT characteristics of these lesions. Hepatic infarctions appear as well-defined, hypodense, wedge-shaped, and geographic lesions extending from the hepatic hilum to the hepatic capsule. Infarctions result from hepatic hypo perfusion with or without associated vascular occlusion, either hepatic arterial or portal venous. The patient population who develop hepatic infarction has not been clearly delineated, but an association of hepatic infarction with surgery involving the porta hepatis, including hepatic transplantation and pancreaticoduodenectomy (Whipple procedure), is suspected.
The complicated postsurgical patient who develops hepatic infarction may be susceptible to additional complications, including infection. Secondary infection of infarcted parenchymal tissue may result in liquefaction and abscess formation. The imaging appearance of hepatic abscesses on CT has been well described as a lesion with a thin enhancing rim with hypoattenuating nonenhancing internal contents. Both portal venous and hepatic venous thrombosis may be associated with hepatic abscess formation. Once parti ally liquefied, infected hepatic infarctions may be suitable for percutaneous abscess drainage. Multiple studies have documented the safety and efficacy of percutaneous abscess drainage, although complications including postprocedure sepsis do occur.
Percutaneous drainage has long been the accepted primary therapy of parenchymal organ abscesses, including those of the liver, but no reports published to date describe the clinical background, imaging appearance, or outcome of patients with percutaneously drained infected hepatic infarctions. The purpose of this investigation was to describe the patient population, imaging characteristics, and success rate of percutaneously drained hepatic infarctions that have become abscesses as the result of secondary infection.
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