Unusual enhancement pattern of liver lesions in hepatosplenic candidiasis

To describe an unusual enhancement pattern of hepatosplenic candidiasis (HSC) liver lesions in biphasic spiral liver computed tomography (CT).

Twenty-one patients with suspected HSC were scanned with a biphasic liver CT perfusion protocol. The liver lesions detected were assessed for their morphology and enhancement pattern during both perfusion phases. A liver biopsy was performed in 11/21 patients.

The majority of hepatic lesions in 15/21 patients showed the well-known abscess-like pattern. In 6/21 patients an uncommon central contrast enhancement with a peripheral double ring was detected in the arterial phase. In some cases the lesions showed decreased diameter or even seemed to disappear completely in the portalvenous phase.

CT in the arterial phase showed an unusual enhancement pattern of liver lesions in HSC. Scanning only in the portalvenous phase implies possible pitfalls, because lesions may be overlooked or undersized. Therefore, biphasic liver CT is considered essential in the diagnosis and follow-up of HSC in clinical practice.