Amoebic hepatic abscesses (CEUS)
Findings in contrast-enhanced ultrasound of liver abscesses depend mainly on the degree of liquefaction and of the size and shape of the liquefied areas. Liquefied areas don´t enhance at all, whereas walls, septa or phlegmonous areas typically enhance during the arterial phase more intensely than the surrounding liver, and washout during portal or late phases.
Amoebic abscesses are usually rounded, with a homogeneous content in greyscale images and a smooth wall.
Pyogenic abscesses may be round too, but oftentimes they have a geographic shape. Greyscale findings range from very typical findings with fluid content with bubbles to non-specific findings such as hypoechoic heterogeneous focal liver lesions. Contrast-enhanced ultrasound allows depicting the internal structure of the abscess and the size of the liquefied area. this information is important since abscesses with multiple septa or small liquefied areas and predominant phlegmonous components are not suitable for drainage.
Candida abscesses are multiple small round hypoechoic lesions, non-enhancing on contrast-enhanced ultrasound. Usually, spleen lesions are present too.