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Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Lim JH, Lee WJ, Lee DH, Nam KJ - Korean J Radiol (2000 Apr-Jun)

Bottom Line: In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment.Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhlim@smc.samsung.co.kr

ABSTRACT

Objective: The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and methods: Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results: CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion: Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

A 50-year-old woman (case 3) presented with fever and chill. White blood cell count was 12,180/mm3, with 28% eosinophilia. CT scan obtained using a conventional technique shows multiseptated, lobulated, low-attenuated lesions with peripheral enhancement in the anterior segment of the right hepatic lobe. Biopsy disclosed periportal eosinophilic infiltration and eosinophilic abscess (not shown).
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Figure 4: A 50-year-old woman (case 3) presented with fever and chill. White blood cell count was 12,180/mm3, with 28% eosinophilia. CT scan obtained using a conventional technique shows multiseptated, lobulated, low-attenuated lesions with peripheral enhancement in the anterior segment of the right hepatic lobe. Biopsy disclosed periportal eosinophilic infiltration and eosinophilic abscess (not shown).

Mentions: Five patients with segmental and/or subsegmental involvement (case 3-7) were found to have a few or multiple, medium-sized or small, oval or wedge-shaped low-attenuated lesions, varying in size from 1 to 4 cm, in both lobes of the liver (Fig. 3). Lesion margins were either distinct or indistinct, and some were confluent. In two patients (cases 4 and 7) who underwent three-phase helical CT scanning, segmental and subsegmental low-attenuated lesions were prominent during portal venous phase CT, but these were not prominent or were totally invisible on both arterial and delayed phase CT images. In one patient (case 4), the posterior segmental branch of the right portal vein was significantly narrowed. One patient with subsegmental involvement (case 3) exhibited clustered, round or oval low-attenuated lesions, with enhanced rims in the anterior segment of the right hepatic lobe (Fig. 4).

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Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Lim JH, Lee WJ, Lee DH, Nam KJ - Korean J Radiol (2000 Apr-Jun)

A 50-year-old woman (case 3) presented with fever and chill. White blood cell count was 12,180/mm3, with 28% eosinophilia. CT scan obtained using a conventional technique shows multiseptated, lobulated, low-attenuated lesions with peripheral enhancement in the anterior segment of the right hepatic lobe. Biopsy disclosed periportal eosinophilic infiltration and eosinophilic abscess (not shown).
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Figure 4: A 50-year-old woman (case 3) presented with fever and chill. White blood cell count was 12,180/mm3, with 28% eosinophilia. CT scan obtained using a conventional technique shows multiseptated, lobulated, low-attenuated lesions with peripheral enhancement in the anterior segment of the right hepatic lobe. Biopsy disclosed periportal eosinophilic infiltration and eosinophilic abscess (not shown).
Mentions: Five patients with segmental and/or subsegmental involvement (case 3-7) were found to have a few or multiple, medium-sized or small, oval or wedge-shaped low-attenuated lesions, varying in size from 1 to 4 cm, in both lobes of the liver (Fig. 3). Lesion margins were either distinct or indistinct, and some were confluent. In two patients (cases 4 and 7) who underwent three-phase helical CT scanning, segmental and subsegmental low-attenuated lesions were prominent during portal venous phase CT, but these were not prominent or were totally invisible on both arterial and delayed phase CT images. In one patient (case 4), the posterior segmental branch of the right portal vein was significantly narrowed. One patient with subsegmental involvement (case 3) exhibited clustered, round or oval low-attenuated lesions, with enhanced rims in the anterior segment of the right hepatic lobe (Fig. 4).

Bottom Line: In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment.Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhlim@smc.samsung.co.kr

ABSTRACT

Objective: The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and methods: Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results: CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion: Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2718171&rFormat=json&query=null&req=5