Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

2021 ◽  
Author(s):  
Giampiero Francica ◽  
Maria Franca Meloni ◽  
Laura Riccardi ◽  
Ilario de Sio ◽  
Eugenio Caturelli ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Incidental Finding ◽  
Chronic Liver ◽  
Arterial Phase ◽  
Contrast Enhanced Ultrasound ◽  
Diagnostic Modality ◽  
Contrast Enhanced ◽  
Early Arterial Phase

Abstract Purpose This multicenter retrospective study highlights the contrast-enhanced ultrasound (CEUS) findings in a series of histologically proven solitary necrotic nodules (SNN) of the liver, a poorly understood pathologic entity of uncertain origin that mimics malignancy. Materials and Methods 22 patients (M/F 13/9; mean age 59.4 years, SD ± 10.7, range 35–81) with histological diagnosis of SNN and CEUS were selected from clinical, imaging, and pathological archives of 7 US interventional centers, each of which provided 1 to 6 cases (mean 2.8). Pathological diagnosis was made on 20 US-guided biopsies and 2 surgical specimens. 2 patients had 2 SNNs with identical CEUS findings so that imaging analysis was carried out on 24 nodules. Results SNN was an incidental finding in healthy people in 10 cases (45.5 %), and it was discovered during follow-up for either known extrahepatic malignancies (9 cases = 41 %) or chronic liver disease (3 cases = 13.5 %). SNNs had a mean size of 19.3 mm (SD ± 6.5, range 9–40). On B-mode US, SNNs appeared hypoechoic in 14 cases (66.7 %), “target-like” in 7 cases (29.2 %), and homogeneously hyperechoic in 1 case (4.1 %). On CEUS, all lesions appeared devoid of contrast enhancement (“punched out” aspect) in the arterial, portal venous, and late phases after US contrast agent injection. A uniformly thin, hyperenhancing ring in the early arterial phase and isoenhanced with the surrounding parenchyma in the portal venous and late phases was found in 10 nodules (41.6 %). Clinical and imaging follow-up (mean duration 42.2 months, SD ± 34.9, range 2–108) was available in 15 patients with 16 SNNs: no changes in size and echostructure were seen. Conclusion CEUS can contribute to the diagnosis of SNN when a “punched out” appearance in all vascular phases with or without thin rim enhancement in the very early arterial phase is present in healthy subjects in whom a focal liver lesion is incidentally found. In patients with a history of chronic liver disease or malignancy, US-guided biopsy represents the unavoidable first-line diagnostic modality.

scholarly journals Outcomes of excessive alcohol drinkers without baseline evidence of chronic liver disease after 15 years follow-up: Heavy burden of cancer and liver disease mortality

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252218
Author(s):  
Sónia Bernardo ◽  
Ricardo Crespo ◽  
Sofia Saraiva ◽  
Rui Barata ◽  
Sara Gonçalves ◽  
...  
Keyword(s):  
Liver Disease ◽  
Alcohol Consumption ◽  
Chronic Liver Disease ◽  
Alcohol Intake ◽  
Chronic Liver ◽  
Portuguese Population ◽  
Heavy Drinkers ◽  
Heavy Burden

Background Most long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline. Methods A cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018. Results At baseline (2002), median alcohol consumption was 271±203g/day during 21.5±20 years, 65% being abstinent during the previous 1.75±5 months. Patients were followed for 14±3 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01–1.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01–1.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer–mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69–74] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively. Conclusion Long-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.

scholarly journals Chronic Hepatitis C Virus Infection After Treatment for Pediatric Malignancy

Blood ◽  
1997 ◽  
Vol 90 (3) ◽  
pp. 1315-1320 ◽  
Author(s):  
Simone Cesaro ◽  
Maria Grazia Petris ◽  
Flavio Rossetti ◽  
Riccardo Cusinato ◽  
Corrado Pipan ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
Virus Infection ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Hcv Infection ◽  
Pediatric Malignancy ◽  
Infection Markers

Abstract Sera of 658 patients who had completed treatment for pediatric malignancy were analyzed by a second-generation enzyme-linked immunosorbent assay and recombinant immunoblot assay test to assess the prevalence of hepatitis C virus (HCV)-seropositivity. All HCV-seropositive patients underwent detailed clinical, laboratory, virologic, and histologic study to analyze the course of HCV infection. One hundred seventeen of the 658 patients (17.8%) were positive for HCV infection markers. Among the 117 anti-HCV+ patients, 41 (35%) were also positive for markers of hepatitis B virus infection with or without delta virus infection markers, 91 (77.8%) had previously received blood product transfusions, and 25 (21.4%) showed a normal alanine aminotransferase (ALT) level during the last 5-year follow-up (11 of them never had abnormal ALT levels). The remaining 92 patients showed ALT levels higher than the upper limit of normal range. Eighty-one of 117 (70%) anti-HCV+ patients were HCV-RNA+, with genotype 1b being present in most patients (54%). In univariate analysis, no risk factor for chronic liver disease was statistically significant. In this study, the prevalence of HCV infection was high in patients who were treated for a childhood malignancy. In about 20% of anti-HCV+ patients, routes other than blood transfusions are to be considered in the epidemiology of HCV infection. After a 14-year median follow-up, chronic liver disease of anti-HCV+ positive patients did not show progression to liver failure.

scholarly journals A Rare Intrasplenic Varix in a Patient with Chronic Liver Disease and Portal Hypertension

2018 ◽  
Vol 01 (01) ◽  
pp. 060-064
Author(s):  
Sivasundhar Kumarasamy ◽  
Karumuri Srinivas Sekhar ◽  
Malathi Vaithyanathan ◽  
Saravanakumar Sengottaiyan ◽  
Saravanan Thangam Shanmugasundaram
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Road Traffic ◽  
Splenic Vein ◽  
Chronic Liver ◽  
Computed Tomographic ◽  
Contrast Enhanced ◽  
Rare Manifestation ◽  
Venous Collaterals

AbstractWe present a rare case of spontaneous intrasplenic varix in a patient with chronic liver disease and portal hypertension. The venous collaterals and presence of portal hypertension was incidentally detected by abdominal contrast-enhanced computed tomographic imaging during evaluation of a suspected abdominal trauma following a road traffic accident. There have been a few reports of splenic vein aneurysms in the extrasplenic location. To the best of our knowledge, this is the first reported case of intrasplenic varix that developed in an adult with chronic liver disease and portal hypertension which is a rare manifestation of a well-known disease.

Contrast Enhanced Ultrasound Sonography in Intestinal Acute Graft Versus Host Disease: Advantages of Non-Invasive Anatomic and Physiologic Measurements.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4493-4493
Author(s):  
Edoardo Benedetti ◽  
Benedetto Bruno ◽  
George B. McDonald ◽  
Francesco Caracciolo ◽  
Federico Papineschi ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Terminal Ileum ◽  
Acute Gvhd ◽  
Arterial Phase ◽  
Contrast Enhanced Ultrasound ◽  
Intestinal Microcirculation ◽  
Contrast Enhanced ◽  
Intestinal Gvhd ◽  
Steroid Refractory

Abstract Abstract 4493 Introduction Acute GVHD involving the gastrointestinal tract is now the major cause of non-relapse mortality following allogenic transplant. Diagnosis remains problematic for some patients with pathology in the mid-gut; there is significant sampling error with mucosal biopsy; we lack objective measures of physiologic improvement or worsening in the gut; and duration of immune suppressive therapy remains imprecise. To address these issues, we have serially evaluated intestinal pathology in patients with acute GVHD using a reproducible ultrasound technique as a proof of principle study. Specifically, we examined the hypothesis that contrast-enhanced ultrasound (CEUS) could detect an enhancement of microcirculation during active intestinal acute GVHD as a diagnostic tool and that CEUS could be used to serially assess physiologic changes after treatment. Methods Four patients (pts) with hematologic malignancy (1 each with ALL, AML, mantle cell lymphoma, and myeloma) received a matched unrelated donor allogenic transplant after a myeloablative (N=2), reduced intensity (N=1), or non-myeloablative (N=1) conditioning. GVHD prophylaxis consisted of cyclosporine with either short course methotrexate (N=3) or mycophenolate mofetil (N=1). All patients developed biopsy-proven intestinal GVHD that was steroid refractory in 2 patients. At GVHD onset, patients were scanned with transabdominal ultrasonography and subsequently by CEUS using a linear phased-array 7.5-MHz transducer. A second generation echo-contrast agent (SonoVue®, Bracco), which consists of microbubbles stabilized by phospholipids and filled with sulphur hexafluoride, was injected i.v. as a bolus (2.4 mL) followed by 5 mL saline flush. Microbubbles have a mean diameter of 2.5 μm and remain within the vascular space allowing real-time imaging of microcirculation. Results In all patients, routine ultrasonography revealed mucosal edema involving the terminal ileum in 3 patients (wall thickness 5.1, 5.8 and 7.9 mm) and the colon in 4 patients (ascending colon 5.8, 6, 8.4 and 18 mm; transverse colon 6 and 12.6 mm; descending colon 11 mm). CEUS at GVHD onset showed an arterial phase (AP) complete enhancement of the entire wall section from the mucosal to the serosal layer (terminal ileum) in 2 patients. There was absence of enhancement only in the outer border of the muscularis propria in 1 patient (pt); there was absence of enhancement both in the outer and in the inner border of the colon wall and enhancement only of the intermediate layer in 1 pt. All patients showed late parenchymal phase (PP) wash out. These enhancement patterns have previously been described in active Crohn's disease (Serra C. et al; 2007). CEUS follow-up findings on serial examinations: 1) allowed us to monitor residual disease in one pt after Infliximab, showing persistent AP enhancement of microcirculation suggesting residual GVHD activity which required further treatment with eventually complete remission; 2) CEUS showed normalization and/or decreased microcirculation enhancement in pts responding to treatment (N=2); 3) CEUS showed AP microcirculation enhancement when GVHD flared (N=2); 4) CEUS showed persistence of AP enhancement of microcirculation after Rituxan (4 doses 375mg/m2/weekly) despite a decrease in ileum wall thickness and in agreement with only a slight improvement of symptoms in one pt when GVHD flared, 5) CEUS showed no improvement of intestinal microcirculation wall enhancement in steroid refractory aGVHD patients who eventually died (N=2). In one of them there was persistence of AP phase enhancement despite improvement of symptoms suggesting still active disease. Conclusions Contrast enhanced US showed intestinal microcirculation wall enhancement and delayed washout at the onset of GVHD symptoms in areas of the intestine inaccessible to endoscopic evaluation. CEUS findings on serial examinations correlated with incomplete responses and flares of GVHD symptoms (microcirculation enhancement) and responses to therapy (decreased microcirculation activity). CEUS may be useful for both diagnosis and prognosis, as it provides both anatomic and physiologic information about intestinal GVHD. These findings prompted us to design a prospective study to evaluate clinical usefulness of CEUS in diagnosis and follow-up of intestinal acute GVHD. Disclosures: No relevant conflicts of interest to declare.

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