Korean J Radiol.  2000 Jun;1(2):98-103. 10.3348/kjr.2000.1.2.98.

Hypereosinophilic Syndrome : CT Findings in Patients with Hepatic Lobar or Segmental Involvement

• Lim JH
• Lee WJ
• Lee DH
• Nam KJ

• KMID: 966480
• DOI: http://doi.org/10.3348/kjr.2000.1.2.98

Abstract

OBJECTIVE
The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. MATERIALS AND METHODS: Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. RESULTS: CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination dis-closed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. CONCLUSION: Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

Keyword

Liver, CT; Liver, abscess; Liver, disease

MeSH Terms

Adult
Female
Human
Hypereosinophilic Syndrome/pathology/*radiography
Liver/pathology
Liver Diseases/pathology/*radiography
Male
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A 37-year-old man (case 1) presented with right flank pain. Peripheral white blood cell count was 45,100/mm3, with 94% eosinophilia. A. Arterial phase CT scan shows a small, wedge-shaped low-attenuated lesion in the peripheral part of the posterior segment of the right hepatic lobe (white arrow). Attenuation of the right hepatic lobe is slightly lower than that of the left lobe. The diameter of the posterior branch of the portal vein (arrowheads) is less than 50% of normal. Note the right hepatic artery (black arrow). The liver is moderately enlarged. B. CT scan at 3.5 cm cephalad to A in the portal venous phase shows low attenuation at the right hepatic lobe, with slight heterogeneity. Note the sharp border between the lesion and normal parenchyma (open arrow). C. CT scan at the same level as A during the portal phase shows heterogeneous low attenuation in the right hepatic lobe, with a sharp straight border (open arrow). A small subsegmental low attenuated lesion was also seen in the medial segment of the left hepatic lobe (arrow). Note abrupt narrowing of the posterior branch of the right portal vein. D. CT scan during the equilibrium phase shows a small, wedge-shaped low attenuated lesion in the right hepatic lobe (the same area as in A, open arrow) and another area of faint low attenuation (arrow). Note the significantly narrow posterior branch of the right portal vein (arrowheads). E. Follow-up CT scan one month after corticosteroid treatment shows a subsegmental, faint zone of low-attenuation zone (open arrow) and a tiny subcapsular low attenuated lesion (arrow). Note the presence of normal portal venous branches in the posterior segment of the right hepatic lobe (arrowheads). F. Photomicrograph of needle biopsy specimen reveals severe infiltration of the periportal area by eosinophils and mononuclear cells, resulting in widening of this area and destruction of the hepatic cell cord architecture. Note infiltration of the wall of the portal venule by eosinophils (arrows) and mononuclear cells (arrowheads), resulting in thickening of the wall as well as distortion and narrowing of the lumen (H & E, × 400).

• 

  Fig. 2 A 17-year-old man (case 2) presented with swelling of the upper and lower extremities. White blood cell count was 34,700/mm3, with 72% eosinophilia. A, B. CT scan obtained conventionally, during the portal venous phase, shows peripheral low attenuation with an irregular, ragged margin along the subcapsular area of the right hepatic lobe. Note the two small splenic lesions (B) (arrows). The hepatic parenchyma adjacent to the low attenuated lesion is slightly higher in attenuation. The liver is moderately enlarged. Liver biopsy revealed severe infiltration of the periportal area and central veins by eosinophils, as well as hepatic parenchymal infarction (not shown).

• 

  Fig. 3 A 27-year-old man (case 5) presented with epigastric discomfort. White blood cell count was 44,100/mm3, with 85% eosinophilia. CT scan obtained using a conventional technique shows multiple, well- or ill-defined, round, oval or wedge-shaped low-attenuated lesions of both lobes of the liver. Note the presence of a segmental lesion in the posterior part of the lateral segment of the left hepatic lobe (arrows). Liver biopsy revealed portal and periportal eosinophilic infiltration (not shown).

• 

  Fig. 4 A 50-year-old woman (case 3) presented with fever and chill. White blood cell count was 12,180/mm3, with 28% eosinophilia. CT scan obtained using a conventional technique shows multiseptated, lobulated, low-attenuated lesions with peripheral enhancement in the anterior segment of the right hepatic lobe. Biopsy disclosed periportal eosinophilic infiltration and eosinophilic abscess (not shown).

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