title: Septic liver: clinical relevance of early inhomogeneous enhancement of the liver in patients with acute pyelonephritis.
abstract: BACKGROUND
  CT scans of patients with febrile illness occasionally show hepatobiliary changes, although infection does not originate in the hepatobiliary system. These findings may cause radiologists and clinicians to misrecognize hepatobiliary diseases and initiate an inappropriate treatment. Thus, it is important to recognize hepatobiliary CT findings in cases of extrahepatobiliary infectious disease.
  
  
  OBJECTIVE
  To evaluate extrarenal CT manifestations in patients with acute pyelonephritis and to determine the correlation between these extrarenal CT findings and septic liver based on laboratory parameters of sepsis.
  
  
  METHODS
  This study included 157 retrospectively identified patients with confirmed acute pyelonephritis based on CT imaging and urine test, and who had also undergone multi-phase dynamic contrast-enhanced CT scan. Two radiologists reviewed CT findings including early inhomogeneous enhancement of the liver, periportal low density and gallbladder edema, which were correlated with laboratory data including liver function enzymes, albumin, C-reactive protein, white blood cell count, and results of a blood culture by using the Fisher's exact test and Mann-Whitney U test.
  
  
  RESULTS
  Forty-six patients (29.3%) showed early inhomogeneous enhancement of the liver, which was associated with increased C-reactive protein (P < 0.001), a positive blood culture (P < 0.005), and decreased albumin level (P < 0.002). The periportal low density and gallbladder wall edema were noted in 15 patients (9.6%) and six patients (3.8%), respectively. These two CT findings were significantly associated with only decreased albumin level (P < 0.001 and P < 0.040).
  
  
  CONCLUSIONS
  Early inhomogeneous enhancement of the liver in patients with acute pyelonephritis was significantly associated with increased CRP level, a positive blood culture and decreased albumin level, reflecting sepsis and sepsis-associated liver dysfunction, requiring rapid and appropriate intensive treatment.
authors.affiliation: Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan.
authors.forename: Ga Jin
authors.initials: GJ
authors.lastname: Han
authors.forename: Nam Kyung
authors.initials: NK
authors.lastname: Lee
authors.forename: Suk
authors.initials: S
authors.lastname: Kim
authors.forename: Tae Un
authors.initials: TU
authors.lastname: Kim
authors.forename: Sang Heon
authors.initials: SH
authors.lastname: Song
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Kim
authors.forename: Hong Jae
authors.initials: HJ
authors.lastname: Jo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011704:Pyelonephritis / Q000150:complications / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide
keywords: CT; Liver; biliary; infection; inflammation; kidney