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Type:
Educational Exhibit
Keywords:
Education, CT, Liver, Abdomen, Infection, Ischaemia / Infarction
Authors:
A. Ferrari1, F. Schirru2, F. lavra3, M. Porcu3, L. Casciu3, A. Balestrieri3, L. Saba3; 1Monserrato/IT, 2Nurri/IT, 3Cagliari/IT
DOI:
10.1594/ecr2017/C-0981
Background
The presence of gas in the liver is often associated with potentially fatal conditions.
First studies in literature correlated this condition to a variable mortality,
between 75% and 80%; more recent studies have reviewed these statistics,
evaluating a percentage of about 25% of exitus.
This may be due to the higher incidence of iatrogenic causes (usually associated with lower mortality),
to an earlier diagnosis based on the observation of small bubble gas in the liver by CT and US and to improved therapies.
Wolfe and Evans in 1955 described the first report of intrahepatic gas,
as a sign of necrotizing enteritis child; over the years reports of air in the liver have significantly increased,
mainly because of interventional,
endoscopic and radiological,
procedures.
Generally we distinguish two categories: iatrogenic and non-iatrogenic causes.
We can further subdivide the two categories according to the location in which the included air is localized: biliary tract,
portal vein and hepatic parenchyma (Fig.
1).
Fig. 1: Possible causes of hepatic gas
Considering the great variety of events that can cause the presence of gas in the liver,
it is essential to know the radiological signs suspected of malignant rather than a benign disease,
so setting an appropriate and timely therapeutic procedure.
In this paper we will present some of these causes,
more or less frequent,
associated with mortality; we will analyse their imaging features and the most common differential diagnosis when it is possible,
through the presentation of our cases and a review of the literature.