Ultrasound features - ✅ Hepatic Abscess 🎯
* Complex cystic hepatic lesion with thick, wall and internal debris.
* Posterior acoustic enhancement ± septations/loculations.
* Peripheral hyperemia on Doppler, with absent/minimal internal vascularity.
* Gas with dirty shadowing, when present, strongly supports abscess.
* Adjacent inflammatory change may be present.
Differentials
* Amoebic abscess: sonographically overlaps considerably; clinical/serological correlation is needed.
* Necrotic metastasis/HCC: consider if there is a vascularized solid component, mural nodule, multiple lesions, known malignancy or tumour thrombus.
* Infected cyst: usually a pre-existing cyst with new wall thickening/debris.
* Hydatid cyst: daughter cysts, membranes or calcification favour the diagnosis.
* Cystic neoplasm: thick vascularized septa or mural nodules favour neoplasm.
* Hematoma: trauma/intervention history and lack of inflammatory hyperemia favour this diagnosis.
Impression
Thick-wall...
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