Visceral organ abscesses in melioidosis: sonographic findings

We describe the sonographic appearances of extrapulmonary visceral organ abscesses in melioidosis and examine the role of sonography in early detection and follow-up of this elusive disease.

The sonograms and records of 80 patients with melioidosis were retrospectively reviewed. The number, size, sonographic appearances, and distribution of abscesses in the abdominal visceral organs were analyzed.

The most common suspected diagnoses upon hospital admission were septicemia and pyrexia of unknown origin (39%). Abdominal visceral organ abscess was suspected in only 28% of patients. Fifty-seven patients (71%) had single organ involvement, and 23 (29%) had multiple organ involvement. There were lesions in the spleen in 59 patients (74%), liver in 37 (46%), and kidney in 10 (12%). Multiple abscesses were much more common than a solitary abscess in each organ and were demonstrated in 83%, 68%, and 75% of patients with spleen, liver, and kidney involvement, respectively. The sonographic findings of multiple small abscesses with a "target-like" appearance and larger multiloculated abscesses were common in every organ.

The findings of multiple small, discrete abscesses in visceral organs, particularly the spleen, should raise the suspicion of this disease. In endemic areas, screening sonography should be done in every patient presenting with septicemia or fever of unknown origin.