Fungal liver abscesses in acute leukaemia--a report of two cases
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1Department of Radiology, Royal Manchester Childrens Hospital, Pendlebury.
Abstract:
The radiological findings in two cases of hepatic fungal microabscesses (one with concomitant splenic involvement) occurring in children with acute leukaemia are presented, and the previous literature is reviewed. Usually both liver and spleen are involved, though either organ may be affected in isolation. Typical ultrasound features include hepatosplenomegaly with multiple hypoechoic areas throughout the liver and spleen, often with a 'target' configuration. Computed tomography shows these as multiple non-enhancing low attenuation lesions. These findings in a patient with acute leukaemia are strongly suspicious of fungal infection, and percutaneous fine-needle aspiration under ultrasound or computed tomography-guidance is indicated.
Insights
Fungal microabscesses in children with acute leukemia can affect the liver and spleen. Imaging reveals characteristic patterns, prompting further diagnostic aspiration for fungal infection.
Area of Science:
- Radiology
- Pediatric Oncology
- Infectious Diseases
Background:
- Fungal microabscesses are a rare but serious complication in immunocompromised children, particularly those with acute leukemia.
- Early diagnosis and treatment are crucial to improve outcomes in pediatric patients with hematologic malignancies.
Observation:
- This study presents two pediatric cases of hepatic fungal microabscesses, one with concurrent splenic involvement, in children diagnosed with acute leukemia.
- Radiological review highlights typical imaging features observed in ultrasound and computed tomography (CT) for these infections.
Findings:
- Ultrasound commonly demonstrates hepatosplenomegaly with multiple hypoechoic lesions in the liver and spleen, often exhibiting a 'target' appearance.
- CT scans reveal these lesions as multiple, non-enhancing areas of low attenuation within the affected organs.
- The combination of these imaging findings in a child with acute leukemia strongly suggests a fungal etiology.
Implications:
- The characteristic radiological findings serve as a critical indicator for suspected fungal infection in pediatric leukemia patients.
- Percutaneous fine-needle aspiration, guided by ultrasound or CT, is recommended for definitive diagnosis and timely initiation of antifungal therapy.