金子 宏¹, 細川 武彦², 兼城 賢明², 森瀬 公友³

Hiroshi KANEKO¹, Takehiko HOSOKAWA², Kenmei KANESHIRO², Kimitomo MORISE³

¹愛知医科大学第四内科, ²公立学校共済組合東海中央病院内科, ³名古屋大学第一内科

¹The Fourth Department of Internal Medicine, Aichi Medical University, ²Department of Internal Medicine, Tokai Central Hospital, ³The First Department of Internal Medicine, Nagoya University School of Medicine

キーワード : Liver abscess, Echo pattern

Changes in echo patterns were analyzed in 16 patients with liver abscesses (6 males and 10 females, age range: 33-86 yrs). Some patients had associated diseases: gall stone (1 case), advanced gastric carcinoma (1 case), Hashimoto disease (1 case), acute myocardial infarction (1 case), and diabetes mellitus (5 cases). Of these 16 patients, correct diagnosis of the liver abscess was made by means of ultrasonograpy (US) in 14 cases. The abscess was solitary in 12, and multiple in 4. The abscess was found in the right lobe in 14 cases, and in the left lobe in 2. The size of abscess was ranged 1.6 to 11.0 cm in diameter. US-guided aspiration revealed that causative organisms in abscesses were K. pneumoniae in 8, and E. coli in 2. Continuous drainage was performed in 10 cases, aspiration without drainage in 5, and conservative chemothrapy in one.
In active stages, a thin wall with hyperechoic layer was found in 8, while a poor wall was found in 7. The echo patterns of the internal echo were hyperechoic in 1, mixed-echoic in 6, and hypoechoic in 8. A hyperechoic pattern was detected in the case, in which it took 3 days for diagnosis from the onset of symptoms. In healing stage, a thick wall with hyperechoic layer was found in 1. In half of all the cases, echogenicity of abscess internal echo became lower. As other findings of the healing stage, a central high echo which suggested gas in the abscess was detected in 4 cases, marginal hypoechoic layer in 4 cases. The abscess cavity was decreased rapidly in cases which showed the US pattern of a central high echo with peripheral hypoechoic layer. All patients were cured except one patient, who died from gastric carcinoma.
We concluded that an ultrasound scan is useful not only for the diagnosis but also for the evaluation of healing in patients with liver abscesses.