Learning objectives
The purpose of our educational exhibit is to summarise and illustrate:
The characteristic CT imaging features of hepatobiliary, genitourinary, colonic and musculoskeletal emphysematous infections.
Identify key imaging findings of benign aetiologies.
Background
Emphysematous conditions of the abdomen and pelvis are a result of a broad spectrum of diseases. Emphysematous infections represent potentially life-threatening conditions that require aggressive medical and often surgical management. Initial clinical manifestations may be non-specific and insidious with progression to sepsis without early intervention.[Fig 30]
Emphysematous infection is strongly associated with diabetes mellitus (1), and is usually caused by gram negative bacteria e.g. Escherichia coli orKlebsiella pneumoniae(2, 3). The severity and treatment of the underlying conditions varies immensely and so accurate differentiation between them...
Findings and procedure details
Emphysematous Hepatitis
Emphysematous hepatitis (EH) is a rare condition characterised by imaging findings of progressive replacement of hepatic parenchyma by gas with out any fluid component or mass effect (5). [Fig 1]
Differential Diagnosis/Mimics:
1. Pyogenic liver abscess (PLA), where the fluid component is the fundamental difference between PLA and EH (7). Pyogenic hepatic abscesses on CT are typically encapsulated hypo-densities exerting mass effect on adjacent structures which may 'cluster' or multiple lesions coalescing into a single larger lesion.Occasionally PLAs will contain gas bubbles or...
Conclusion
CT is considered the modality of choice to reliably depict the anatomic location and extent of abdominopelvic gas. CT is the first line problem-solving tool in the evaluation of abdominal emphysematous conditions allowing for prompt and accurate radiological diagnosis.
Personal information and conflict of interest
N. Poole:
Nothing to disclose
S. Fossey:
Nothing to disclose
J. Black:
Nothing to disclose
References
1. Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002;22(3):543-61.
2. Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2011;107(9):1474-8.
3. Amano M, Shimizu T. Emphysematous cystitis: a review of the literature. Intern Med. 2014;53(2):79-82.
4. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28(1):255-77; quiz 327-8.
5. Ghosn Y, Abdallah A, Hussein Kamareddine M, Geahchan A, Baghdadi A, El-Rassi Z, et al. Gas-Forming Liver Abscess versus Emphysematous Hepatitis: A...