Hepatosplenic candidiasis: wheels within wheels

Area of Science:

• Medical Imaging
• Radiology
• Infectious Diseases

Background:

• Candidiasis, a fungal infection, poses a significant risk to immunocompromised cancer patients.
• Accurate and timely diagnosis of hepatic and splenic candidiasis is crucial for effective treatment.

Purpose of the Study:

• To evaluate the effectiveness of serial abdominal ultrasound (US) and computed tomography (CT) in diagnosing hepatic and splenic candidiasis.
• To identify characteristic imaging patterns associated with candidiasis in immunocompromised patients.

Main Methods:

• Eight immunocompromised cancer patients with confirmed candidiasis underwent serial abdominal US and CT scans.
• Imaging findings were analyzed for patterns of hepatic and splenic involvement.
• Comparison of US and CT (nonenhanced and enhanced) detection capabilities was performed.

Main Results:

• Four distinct patterns of hepatic and splenic candidiasis were identified on US, including a "wheels-within-wheels" pattern.
• Nonenhanced CT revealed periportal linear areas of increased attenuation, potentially calcified.
• Some abscesses were better visualized with contrast enhancement, while others were seen on nonenhanced scans.
• US and CT demonstrated complementary detection of lesions, with some lesions visible on one modality but not the other.
• Pathological confirmation of candidiasis occurred in two cases despite normal imaging studies.

Conclusions:

• A combination of US and both nonenhanced and enhanced CT provides maximum sensitivity for detecting hepatic and splenic candidiasis.
• Even with negative imaging results, a strong clinical suspicion for candidiasis necessitates open biopsy for definitive diagnosis.