1Section of Abdominal Ultrasound Kobe City General Hospital, 2Division of Gastroenterology Kobe City General Hospital
Hepatic abscess, Color Doppler imaging, Efferent boood flow
Color Doppler imaging is a new diagnostic imaging tool, which provides vascular information in addition to an ordinary ultrasonographic image. Presented in this report is a case of hepatic abscess, in which interesting hemodynamic changes were clearly demonstrated by a serial study with color Doppler imaging. A 66-year-old male was admitted to our hospital chiefly complaining of fever and general malaise. Two weeks prior to admission, he had fever and a general malaise, which did not improve despite ingestion of an antifebrile. Upon admission, his general condition was poor primary because of septic shock. He was diagnosed as having a hepatic abscess by ultrasonography (US) and CT, which clearly demonstrated an irregular low density area in the right lobe. His general condition drastically improved after the percutaneous transhepatic drainage of the hepatic abscess combined with infusion of antibiotics. The patient was discharged on the 30th day after admission and has been doing well since. Color Doppler imaging was performed on the 2nd, 15th, and 30th hospitalized day, and 6 months later. Arterial pulsatile waveform signals, which resemble the abscess and efferent continuous waveform signal, which emerge from the abscess, were demonstrated by color Doppler imaging on the second hospitalized day. On the 15th hospitalized day, both the pulsatile flow signal and regurgitating signal could still be detected, although the width and maximum velosity of the regurgitating flow signal diminished. On the 30th hospitalized day, the regurgitating flow signal could be detected merely by color Doppler imaging and the regurgitating continuous wave was not demonstrated by the pulsed Doppler spectrum analysis. Six months later, the abscess did not show up under plain US and pulsatile and continuous waveform color signals were visible in the normal direction. In conclusion, color Doppler imaging is an extremely useful tool in demonstrating hemodynamic alteration over time in a hepatic abscess with the progress of the healing process.