Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings

Pneumatosis: Appearances on CT Imaging

BACKGROUND

Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments.

PURPOSE

In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues.

METHODS

On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema.

RESULTS

Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum.

CONCLUSION

Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology.

Emphysematous hepatitis with successful treatments: A rare case report

RATIONALE

Emphysematous hepatitis (EH) is a rare and fulminant gas-forming liver infection. Only 3 patients were successfully treated. Diabetes mellitus and a history of digestive system cancer may predispose individuals to EH. Computed tomography (CT) findings support the diagnosis of EH and monitor progress.

PATIENT CONCERNS

A 48-year-old man with diabetes presented with nausea, vomiting (gastric contents) and diarrhea. Laboratory test results revealed elevated levels of inflammatory indicators and abnormal liver function. CT showed a large-scale air collection with some remaining parenchymal debris in the left lobe of the liver. Remarkably, no fluid was observed inside the lesion.

DIAGNOSE

The abdominal CT features and laboratory examination results rationalized the diagnosis of EH.

INTERVENTIONS AND OUTCOMES

The patient finally recovered from this severe disease through a series of effective treatments, including strict glucose control, sensitive antibiotic therapy, and subsequent percutaneous drainage.

LESSONS

EH generally deteriorates rapidly and eventually leads to death. This case will raise awareness of the rare and severe disease, strengthen diagnostic capacities, and provide advice to treat it.

Unexpected Death Associated With Clostridial Sepsis

ABSTRACT

An 85-year-old woman with a history of breast carcinoma presented to hospital after gradual onset of abdominal pain with hypotension, jaundice, and massive intravascular hemolysis. This was caused by Clostridium perfringens septicemia originating from a liver abscess. Clostridium perfringens septicemia is a rare infection that has a high mortality rate, given that it is frequently unable to be diagnosed until postmortem examination. The source of the pathogen is usually intra-abdominal. Hepatic abscesses, although an uncommon source of primary clostridial infection, should be considered in such cases.

Imaging spectrum of common and rare infections affecting the lower genitourinary tract

In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.