Computerized Tomographic Findings of Hepatic Fascioliasis Compared with Melioidosis-Caused Liver Abscesses
Nittaya Chamadol MD*, Vallop Laopaiboon MD, MSc*, Pennapa Techasatian MD*, Wattana Sukeepaisanjaroen MD**, Anan Sripanuskul MD***
Affiliation : * Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand *** Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : To compare the computerized tomographic (CT) findings of hepatic fascioliasis (HF) vs. melioidosis-caused liver
(ML) abscesses.
Material and Method: CT images of 15 patients with hepatic fascioliasis (HF) and 16 patients with melioidosis-caused liver
(ML) abscesses were retrospectively reviewed. The authors evaluated and compared HF and ML abscesses (by χ2 and Fisher
exact tests) vis-a-vis their location of liver involvement, size, shape, number, margins, enhancement patterns, subcapsular
lesions, internal architecture, dilatation of intrahepatic bile duct and combination with splenic abscesses.
Results : Fourteen HF patients had only liver abscesses and 1 had combined liver and splenic abscesses. Four ML patients
had liver abscesses alone while 12 had combined liver and splenic abscesses (p = 0.000). Eight of the 15 HF (53.3%) and 2
of the 16 ML (12.5%) patients had subcapsular lesions (p = 0.019). The liver abscesses were round or oval with linear tracts
in 8 of the 15 HF (53.3%) and none of the ML patients (p = 0.001). Between the respective HF and ML patients, there was
a significant difference in those with round shaped in ML (p = 0.008), multiple and conglomerately distributed in HF
(p = 0.050), multiple and discretely distributed in ML (p = 0.001) no (or minimal) peripheral contrast enhancement in HF
(p = 0.011) and moderate or mark peripheral enhancement in ML (p = 0.011).
Conclusion : The CT findings of liver abscesses that helped to differentiate hepatic fascioliasis from melioidosis liver
abscesses were: their number, shape, enhancement pattern, presence of subcapsular lesion (s) and co-occurrence with
splenic abscesses. The diagnosis of hepatic fascioliasis by CT is suggested when the following characteristics were seen: (1)
multiple, small round or oval (with linear tracts) conglomerates presenting as hypodense lesions; (2) no (or minimal)
peripheral contrast enhancement; (3) subcapsular lesions; or (4) less frequent co-occurrence with splenic abscesses.
Keywords : Fascioliasis, Liver abscess, Melioidosis, Tomography, X-ray computed
