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ABDOMINAL ULTRASOUND
trauma may also be iatrogenic, for example following
a biopsy procedure (hence the value of using
ultrasound guidance to avoid major vessels in the
liver) or surgery (Fig. 4.8).
The acoustic appearances depend upon the timing—a
fresh haematoma may appear liquid and
echo-poor, but rapidly becomes more ‘solid’-looking
C
Figure 4.7 cont’d
in a liver abscess.
(C) A percutaneous drain is identified
abscesses are likely to be small but multiple on
presentation. About 25% of infected patients
form hepatic abscesses and the infection may
spread to other sites in the abdomen.
A
Management of hepatic abscesses
An ultrasound-guided aspiration to obtain pus for
culture is useful for identifying the responsible
organism.
Aspiration combined with antibiotic therapy is
usually highly successful for smaller abscesses and
ultrasound is used to monitor the resolution of the
abscesses in the liver.
Ultrasound-guided drainage is used for large
lesions, and surgical removal is rarely required.
Further radiology may be indicated to establish
the underlying cause and extent, for example barium
enema or CT, particularly if amoebic infection
is suspected.
Haematoma
The liver haematoma may have similar acoustic
appearances to those of an abscess, but does not
share the same clinical features. A haematoma is
the result of trauma (usually, therefore, via the
Accident and Emergency department) but the
B
Figure 4.8 (A) Intrahepatic haematoma following a
road traffic accident with rib fractures. The lesion is
relatively fresh and contains some low-level echoes.
(B) 2-day-old subcapsular haematoma. The collection
became progressively smaller and hyperechoic as it
resolved.