1/11. Use of percutaneous drainage to treat hepatic abscess after radiofrequency ablation of metastatic pancreatic adenocarcinoma.Radiofrequency ablation (RFA) is well described in the treatment of primary hepatic malignancies and colorectal carcinoma hepatic metastases. A known complication of RFA is the development of hepatic abscess. The management of hepatic abscesses subsequent to RFA for metastatic disease is not well described. A 49-year-old female with pancreatic adenocarcinoma underwent pancreaticoduodenectomy followed by adjuvant chemoradiation. Following 6 months' treatment, a new liver metastasis was identified. It remained stable for 6 months during additional chemotherapy and thereafter was treated with RFA. Three weeks after RFA, the patient presented with malaise and leukocytosis, and a CT scan demonstrated a large hepatic abscess at the site of the RFA. She remained febrile despite needle aspiration and intravenous antibiotics. A percutaneous drain was placed and the symptoms resolved. Contrast injection of the drain 4 weeks later demonstrated resolution of the abscess cavity but communication with the biliary tree. The drain was removed and the tract embolized with Gel-foam to prevent complications of biliary-cutaneous fistula. She remains well without evidence of abscess or disease recurrence. Thus, RFA can be used in treatment of limited isolated hepatic metastases from previously treated pancreatic adenocarcinoma. However, the incidence of hepatic abscess is increased due to bilioenteric anastomosis; extended antibiotic prophylaxis should be considered.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/11. liver abscess associated with hepatic artery pseudoaneurysm with arteriovenous fistula: imaging and interventional management.hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/11. Multiple hepatic abscesses: cholangiographic changes simulating sclerosing cholangitis and resolution after percutaneous drainage.A 59-yr-old man developed multiple hepatic abscesses following an episode of diverticulitis. A percutaneous transhepatic cholangiogram (PTC) showed changes typical of sclerosing cholangitis complicated by multiple hepatic abscesses. No biliary tract stones were seen either on ultrasound or PTC. A single drain left in the right biliary tree and a course of intravenous antibiotics resulted in complete normalization within 14 days of the previously involved biliary tree.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
4/11. pseudomonas aeruginosa liver abscesses following endoscopic retrograde cholangiography. Report of a case without biliary tract disease.We report a case of pseudomonas aeruginosa liver abscesses following endoscopic retrograde cholangiopancreatography (ERCP) in a patient without evidence of biliary tract disease and of any known cause of hepatic infection. Computer tomography (CT) scan was the best method of diagnosis, allowing, through guided percutaneous puncture of the abscesses, isolation of the organism, which was sensitive to carbenicillin. One month of antibiotherapy with repeated aspirations of the largest abscesses was successful. This report suggests that ERCP may induce cholangitic sepsis by inoculating pathogens in the biliary tree even in the absence of extrahepatic obstruction.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/11. Hepatic abscess due to occult biliary stones.The advent of radiologic percutaneous drainage of abdominal abscesses has revealed that a significant percentage involve a fistulous communication to other organs or structures. We present two cases in which abscessograms revealed unsuspected fistulous communication to an incompletely or intermittently obstructed biliary tree with retained stones.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/11. Endoscopic retrograde cholangiography (ERC) in nonamebic liver abscesses.Two cases of liver abscess are reported in whom the diagnosis was suggested by a combination of liver scanning, ultrasonography, arteriography, and liver biopsy. The diagnosis was confirmed by ERC which showed intrahepatic extravasation of contrast from the biliary tree, a characteristic of liver abscess. The value of ERC in the search for an underlying cause as well as in delineating certain features of the absceses is shown.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/11. Intrahepatic abscess as a complication of long-term percutaneous internal biliary drainage.One hundred five patients with obstructive jaundice have undergone percutaneous transhepatic internal biliary drainage at the Johns Hopkins Hospital. Many of these patients subsequently underwent corrective or palliative surgery, whereas other died of malignant disease after relatively short periods of catheter decompression, Seven of these patients with percutaneous internal biliary drainage, however, have been followed for over 8 months. Three of these seven patients developed intrahepatic abscesses at a mean of 16 months after catheter placement. Two of the three patients died of sepsis. In two of the patients the abscesses communicated with the biliary tree, in the third it did not. Intrahepatic abscess formation may be a common complication of long-term percutaneous transhepatic internal biliary drainage, and it should be suspected in any patient with fever or signs of sepsis who has been followed with catheter drainage for over 6 months.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/11. Biliobronchial fistula following pyogenic liver abscess.A 65-year-old man with malaise, chills and fever was found to have a pyogenic liver abscess. A fistula from the abscess to the bronchial tree was confirmed by bronchoscopy and thoracotomy. In spite of adequate drainage of the abscess, respiratory function deteriorated and the patient died 1 month after operation. Biliobronchial fistula resulting from a pyogenic liver abscess is rare and has not recently been reported in the English or French literature. Reports dating back to the first published case in 1857 are reviewed. Early supradiaphragmatic excision of the fistulous tract and drainage of the hepatic abscess are recommended.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/11. Infective endocarditis in heroin addicts: epidemiological observations and some unusual cases.The total number of cases of heroin-induced endocarditis occurring over a four-year period were reviewed in order to explain an increase in the number of cases in the last year studied (1975). Brown heroin was noted to be used more frequently by addicts during the period of increased incidence. Cultures of "street samples" of brown and white heroin as well as cocaine were obtained in order to elucidate a possible relationship between the increased use of brown heroin and the increased number of endocarditis cases. Despite frequent contamination of both white and brown heroin, none of the common endocarditis-causing pathogens were isolated from the samples. staphylococcus aureus, the most common etiological agent, frequently resulted in tricuspid endocarditis. That the accepted criteria for tricuspid endocarditis may be present without actual cardiac valve involvement is demonstrated by a most unusual case of hepatic vasculature infection.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/11. Resolution of multiple hepatic abscesses following percutaneous transhepatic biliary drainage.In two patients, multiple hepatic abscesses secondary to obstructive cholangitis have resolved following the insertion of drains into the biliary tree by the percutaneous transhepatic route, under local anaesthesia. In the first case, the acute situation was relieved, allowing definitive management by an elective procedure rather than as an emergency. Useful short-term palliation was provided in the second case. Percutaneous transhepatic drainage is a safe and effective alternative to emergency surgery in selected cases.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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