杤尾 人司¹, 冨田 周介², 工藤 正俊², 岡部 純弘², 三村 純², 簑輪 和士¹, 島田 啓子¹, 濵田 充生¹, 樫田 博史², 濵田 一美¹, 平佐 昌弘², 伊吹 康良², 小森 英司², 織野 彬雄², 森本 義人¹, 藤堂 彰男²

Hitoshi TOCHIO¹, Syusuke TOMITA², Masatoshi KUDO², Yoshihiro OKABE², Jun MIMURA², Kazushi MINOWA¹, Keiko SHIMADA¹, Michio HAMADA¹, Hiroshi KASHIDA², Kazumi HAMADA¹, Masahiro HIRASE², Yasuyoshi IBUKI², Hideshi KOMORI², Akio ORINO², Yoshito MORIMOTO¹, Akio TODO²

¹神戸市立中央市民病院臨床病理科腹部超音波室, ²神戸市立中央市民病院消化器センター内科

¹Section of Abdominal Ultrasound Kobe City General Hospital, ²Division of Gastroenterology Kobe City General Hospital

キーワード : 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.