Metastatic Hepatic Actinomycosis

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Metastatic Hepatic Actinomycosis Chih-Yung Yu, MD, Wei-Chou Chang, MD, Hong-Wei Gao, MD, Tsu-Yi Chao, MD, Guo-Shu Huang, MD, Chung-Bao Hsieh, MD The American Journal of Medicine Volume 123, Issue 9, Pages e9-e11 (September 2010) DOI: 10.1016/j.amjmed.2010.01.032 Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 1 (A) CT scan of the pelvis shows a mass with mixed solid and cystic components measuring 6×4 cm on the right side of the uterus in the vicinity of the ovary, with air-bubble component (arrow) and surrounding fatty stranding. (B) CT of the liver also shows a mass with solid and cystic components measuring 10×8 cm in the left lateral segment with ventral bulging and diaphragm infiltration. A poorly enhanced peripheral rim (white arrow) circumscribes this mass. The left portal vein is small, and thrombosis (black arrow) is present. The cystic component of the hepatic mass shows no enhancement, and the impression is an abscess or tumor necrosis. S, Solid component; C, cystic component; U, uterus. The American Journal of Medicine 2010 123, e9-e11DOI: (10.1016/j.amjmed.2010.01.032) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 2 Non-enhanced magnetic resonance image including T1-weighted (A) and T2-weighted (B) images. The solid component of the hepatic mass shows isointensity on both T1- and T2-weighted images. The peripheral rim (white arrow) shows hypointensity on T1-weighted images and hyperintensity on T2-weighted images, in contrast with the surrounding liver parenchyma, which are consistent with perilesional edema. The cystic component shows hypointensity on T1-weighted images and marked hyperintensity on T2-weighted images, and an impression similar to that observed on CT. S, Solid component; C, cystic component. The American Journal of Medicine 2010 123, e9-e11DOI: (10.1016/j.amjmed.2010.01.032) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 3 Sulfur granule surrounded by neutrophils, foaming histiocytes, lymphocytes, and plasma cells (hematoxylin–eosin, ×200). The American Journal of Medicine 2010 123, e9-e11DOI: (10.1016/j.amjmed.2010.01.032) Copyright © 2010 Elsevier Inc. Terms and Conditions