Hepatic Abscess versus Peripheral Cholangiocarcinoma: Sonographic Differentiation.

Chung,  Hwan Hoon; Kim,  Yun Hwan; Kang,  Chang Ho; Chung,  Kyoo Byung; Suh,  Won Hyuck; Lee,  Chang Hee

Journal of Korean Society of Medical Ultrasound 2000;19(4): 245-252.

Hwan Hoon Chung, Yun Hwan Kim, Chang Ho Kang, Kyoo Byung Chung, Won Hyuck Suh, Chang Hee Lee

¹Department of Radiology, Korea University College of Medicine.
²Department of Radiology, Kun-kuk University College of Medicine, Chung-Ju Hospital.

Published online: January 1, 2001.

ABSTRACT

PURPOSE: To find out the sonographic findings that are useful to differentiate hepatic abscess from peripheral cholangiocarcinoma. MATERIALS AND METHODS: Twenty-two hepatic abscesses and 22 peripheral cholangiocarcinomas which had been confirmed histologically were included in this study. Objective points were echo characteristics of the lesion, internal septation, presence of peripheral low echoic rim, demarcation from normal liver(well or poorly defined), posterior enhancement, multiplicity, dilatation of bile duct(obstructive or non-obstructive), intrahepatic duct stone, pleural effusion, and intra-abdominal fluid collection. Echo characteristics of the lesion were classified in-to four types. Type I; Predominantly echogenic with hypoechoic portion, type II; Echogenic without hypoechoic portion, type III; Predominantly hypoechoic with echogenic portion, type IV; Hypoechoic without echogenic portion. RESULTS: 1)Nine abscesses and 2 peripheral cholangiocarcinomas were type I(p=0.037), 2)One abscess and 18 peripheral cholangiocarcinomas were type II(p=0.001), 3)Seven abscesses and none of peripheral cholangiocarcinomas were type III(p=0.001), 4)Five abscesses and 2 peripheral cholangiocarcinomas were type IV(p=0.410). Only 7 abscesses showed internal septations(p=0.013). One abscess and 9 peripheral cholangiocarcinomas showed peripheral hypoechoic halos(p=0.012). Only 9 peripheral cholangiocarcinomas showed obstructive bile duct dilatation (p=0.001). There were no statistically significant differences between abscess and peripheral cholangiocarcinoma on other objective points. CONCLUSION: Predominantly echogenic with hypoechoic portion, predominantly hypoechoic with echogenic portion, and internal septation are the features suggestive of hepatic abscess, and echogenic without hypoechoic portion, peripheral hypoechoic halo, obstructive bile duct dilatation are suggestive of peripheral cholangiocarcinoma. Therefore these sonographic findings are helpful to differentiate hepatic abscess from peripheral cholan-giocarcinoma

Keywords: Liver, US; Liver abscess; Liver, neoplasms