title: Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: a 7-year study.
abstract: OBJECTIVE
  This study aimed to characterise the CT findings associated with hepatic and splenic melioid abscesses.
  
  
  METHODS
  Patients with CT evidence of hepatic and/or splenic abscesses were retrospectively evaluated for clinical evidence of melioidosis over a 7-year period. After blinded review of the CT characteristics of intra-abdominal abscesses (IAA), we conducted a stratified analysis of patients with and without melioid IAA.
  
  
  RESULTS
  Among 49 patients with CT evidence of hepatic and/or splenic IAA, the mean age was 50.2 years, 22 (44.9%) were women and eight (16.3%) had laboratory confirmation of melioidosis. For the 113 IAA, 33 were melioid abscesses (15 liver and 18 spleen) and 80 were non-melioid abscesses (69 liver and 11 spleen). Splenic IAA were more common in the melioid group (P = 0.001) and smaller in diameter than the hepatic IAA (P < 0.001). Melioid IAA were smaller than non-melioid IAA (P < 0.001) and the CT necklace sign was the strongest predictor for melioid IAA (odds ratio = 24.6, P = 0.006) with 100% specificity. Other significant predictors for melioidosis were concurrent hepatic and splenic involvement (P = 0.009), multiple abscesses (P = 0.015) and residence in an endemic area (P = 0.047). By multivariate analysis, concurrent hepatic and splenic involvement was the sole predictor of melioidosis (adjusted odds ratio = 11.3, 95% confidence interval = 1.6-77.5, P = 0.014).
  
  
  CONCLUSIONS
  The CT necklace sign, along with concurrent hepatic and splenic IAA, were highly suggestive of melioidosis in persons from Central Thailand.
authors.affiliation: Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
authors.forename: Piyaporn
authors.initials: P
authors.lastname: Apisarnthanarak
authors.forename: Atita
authors.initials: A
authors.lastname: Thairatananon
authors.forename: Kobkun
authors.initials: K
authors.lastname: Muangsomboon
authors.forename: David S K
authors.initials: DS
authors.lastname: Lu
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mundy
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008100:Liver Abscess / Q000000981:diagnostic imaging* / Q000382:microbiology*; D008297:Male; D008554:Melioidosis / Q000150:complications* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*