Patient with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis showing an abscess in hepatic cysts on diffusion-weighted MR imaging

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  • 拡散強調ＭＲＩ画像が肝嚢胞内の感染巣の同定に有用であった維持透析多発性嚢胞腎患者の１例
  • 症例報告 拡散強調MRI画像が肝嚢胞内の感染巣の同定に有用であった維持透析多発性嚢胞腎患者の1例
  • ショウレイ ホウコク カクサン キョウチョウ MRI ガゾウ ガ カン ノウホウナイ ノ カンセンソウ ノ ドウテイ ニ ユウヨウ デ アッタ イジ トウセキ タハツセイ ノウホウジン カンジャ ノ 1レイ

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The case was a 71-year-old woman with end-stage autosomal dominant polycystic kidney disease (ADPKD) on hemodialysis for 6 years. In early August 2003, she was admitted to our hospital with a high fever over 38°C, general malaise and right-upper abdominal pain. Based on her symptoms and laboratory data, we suspected hepatic or biliary infection. Multiple cysts in the bilateral kidneys and liver were observed on ultrasonography, CT scan and MRI. We could not identify the focus of infection by enhanced CT, T1-weighted MRI or T2-weighted MRI. However, diffusion-weighted MRI (DWI) demonstrated a very high intensity lesion within a hepatic cyst, and the lesion demonstrated a low apparent diffusion coefficient (ADC). From these findings, we diagnosed an abscess in the hepatic cyst and administered antibiotic sulbactam sodium/cefoperazone sodium (SBT/CPZ). The DWI high intensity lesion gradually attenuated in parallel with inflammatory signs and eventually disappeared. In October 2003, DWI high intensity lesion recurred in another hepatic cyst along with signs of systemic infection. This lesion attenuated and disappeared following SBT/CPZ administration similar to the previous lesion. To our knowledge, this is the first report to describe the usefulness of diffusion weighted MRI to identify an infected focus in an ADPKD patient, which was difficult to detect by other conventional imaging studies.

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