Kanzo

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We examined the imaging findings, cyst fluid test results, and therapeutic progress of 23 patients with infected liver cysts between 2009 and 2018. An abdominal ultrasound examination revealed a sludge echo within the cyst in 22 patients, and abdominal contrast-enhanced computed tomography scan revealed contrast enhancement of the cyst wall in 5. Abdominal magnetic resonance imaging was performed in 14 patients. All patients exhibited low-signal intensity within the cyst on the T2-weighted images. Additional diffusion-weighted imaging was performed in 12 patients, in whom low diffusion-weighted signals were observed within the cyst as well as on the cyst border. The cyst fluid culture and blood culture results were positive in 12 and 10 patients, respectively. The most common pathogenic bacteria identified in all patients was Klebsiella pneumoniae. All patients received antimicrobial therapy, fine-needle aspiration, and continuous drainage, whereas 11 received additional sclerotherapy with minocycline hydrochloride. One patient required surgery because of poor drainage. However, all patients were ultimately discharged in remission.

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The patient was a 25-year-old woman. In January 2015, a 23-mm single nodule was found in segment 7 of the liver by ultrasonography. The size of the nodule increased to 52 mm in March 2017, and the patient underwent percutaneous liver biopsy. Focal nodular hyperplasia (FNH) was suspected from the biopsy, but hepatic adenoma (HA) was not ruled out. The nodule size continued to increase after the biopsy, and the patient was transferred to our hospital for consultation. FNH was suspected from the radiological study. However, HA was not excluded as a possibility because the patient had taken an oral contraceptive and the nodule continued to increase in size. An extended right posterior sectionectomy was performed to address the concerns of malignant transformation and bleeding. The final diagnosis from the histological analysis was FNH. Progressive FNH in a young woman taking oral contraceptives is very rare and has not been reported before.

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