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Gastrointestinal Case of the Day¹

¹ From the Department of Radiology, Touro Infirmary, 1401 Foucher St, New Orleans, LA 70115 (V.D.), and the Department of Radiology, Tulane University, New Orleans, La (D.F.-G., M.N.W., B.M.P.). From the 1998 RSNA scientific assembly. Received September 14, 1998; revision requested October 21 and received November 12; accepted November 12. Address reprint requests to B.M.P.

View larger version (131K): [in a new window]   Figure 1.  Longitudinal sonogram of the liver demonstrates a curvilinear formation of bright echo reflectors with associated "ring-down" artifact (arrowheads), a finding suggestive of the presence of gas. Arrows indicate normal liver parenchyma.

View larger version (134K): [in a new window]   Figure 2a.  (a) Abdominal CT scan obtained at the level of the celiac trunk demonstrates a 10 x 8-cm abscess cavity containing a large amount of gas (arrowhead) and a smaller amount of fluid (arrows). An irregularly shaped collection of gas and fluid is seen within the liver straddling the midline. Inflammatory changes are present in the adjacent peritoneal fat anterior to the liver. (b) CT scan obtained at the level of the origin of the superior mesenteric artery reveals a complex collection of gas and fluid divided into two compartments. (c) CT scan shows extension of the abscess cavity into segment IV of the liver. The cavity is seen reaching the hepatic surface adjacent to the proximal duodenum.

View larger version (136K): [in a new window]   Figure 2b.  (a) Abdominal CT scan obtained at the level of the celiac trunk demonstrates a 10 x 8-cm abscess cavity containing a large amount of gas (arrowhead) and a smaller amount of fluid (arrows). An irregularly shaped collection of gas and fluid is seen within the liver straddling the midline. Inflammatory changes are present in the adjacent peritoneal fat anterior to the liver. (b) CT scan obtained at the level of the origin of the superior mesenteric artery reveals a complex collection of gas and fluid divided into two compartments. (c) CT scan shows extension of the abscess cavity into segment IV of the liver. The cavity is seen reaching the hepatic surface adjacent to the proximal duodenum.

View larger version (138K): [in a new window]   Figure 2c.  (a) Abdominal CT scan obtained at the level of the celiac trunk demonstrates a 10 x 8-cm abscess cavity containing a large amount of gas (arrowhead) and a smaller amount of fluid (arrows). An irregularly shaped collection of gas and fluid is seen within the liver straddling the midline. Inflammatory changes are present in the adjacent peritoneal fat anterior to the liver. (b) CT scan obtained at the level of the origin of the superior mesenteric artery reveals a complex collection of gas and fluid divided into two compartments. (c) CT scan shows extension of the abscess cavity into segment IV of the liver. The cavity is seen reaching the hepatic surface adjacent to the proximal duodenum.