Pyogenic liver abscess: Klebsiella as an emerging pathogen.

Patients with pyogenic liver abscesses often present to the emergency department with fever of unknown origin. After the appropriate clinical evaluation, cross-sectional imaging may be performed in the emergent setting to aid in localization of fever source. On computed tomography imaging, pyogenic liver abscesses may present as inflammatory masses in the liver, with Escherichia coli as the most common pathogen. We report an emerging hepatic pathogen as the cause, Klebsiella pneumoniae.

Diagnostic accuracy of time-resolved 2D projection MR angiography for symptomatic infrapopliteal arterial occlusive disease.

OBJECTIVE: Our objective was to evaluate the diagnostic accuracy of time-resolved 2D projection MR angiography in detecting calf and pedal artery occlusive disease. MATERIALS AND METHODS: Time-resolved MR angiography of calf and pedal arteries was performed on 59 symptomatic legs of 52 patients using the head coil and bolus injections of 6 mL of gadolinium contrast medium. Selective X-ray digital subtraction angiography was performed within 30 days after MR angiography. Calf and pedal arteries were divided into 10 segments. X-ray digital subtraction angiography and MR angiography images were retrospectively interpreted by three expert observers, who graded segments as having no significant stenosis, significant stenosis (> 50%), or occlusion. The accuracy of MR angiography interpretations was compared with the accuracy of consensus X-ray digital subtraction angiography interpretations as the standard of reference. Arterial segments with discrepant grading on X-ray digital subtraction angiography and MR angiography were reviewed again to determine the reasons for disagreement. RESULTS: Arterial phase MR angiography images free of venous contamination were obtained in every case. The agreement between MR angiography and X-ray digital subtraction angiography in depicting infrapopliteal arterial disease was fair to good (kappa = 0.44-0.92). Overall sensitivity and specificity were 83% and 87%, respectively, for detecting significant stenosis of calf and pedal arteries and 86% and 93%, respectively, for detecting occlusions. Accuracy was higher in the larger vessels-for example, calf (84%) compared with foot (71%). In 21% (22/105) of the segments graded differently on MR angiography than on X-ray digital subtraction angiography, it was believed that MR angiography was more likely to be correct than X-ray digital subtraction angiography because of visualization of late-filling arteries on MR angiography that did not opacify on X-ray digital subtraction angiography. CONCLUSION: Time-resolved 2D projection MR angiography accurately evaluates calf and pedal arteries without degradation from venous contamination.

Duplex ultrasound evaluation of lower extremity venous insufficiency.

Physicians unfamiliar with venous insufficiency, particularly disorders of the superficial venous system, often underestimate the complexity of the problem and the importance of proper evaluation before initiating treatment. In addition to a directed history evaluation and physical examination, additional evaluation with use of a variety of noninvasive diagnostic instruments, including duplex ultrasound, may be necessary when determining the cause, severity, and best treatment options available for a particular patient. After such evaluation, the treating physician should have a precise map of the patient's pathways of venous insufficiency, including sources of reflux (eg, saphenofemoral junction, saphenopopliteal junction, perforators), tributaries, vein size, and vein morphology.