Author:
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-
1.
Mohsen AH, Green ST, Read RC, McKendrick MW, 2002. Liver abscess in adults: ten years experience in a UK centre. QJM 95: 797–802.
-
2.
Ghosh S, Sharma S, Gadpayle AK, Gupta HK, Mahajan RK, Sahoo R, Kumar N, 2014. Clinical, laboratory, and management profile in patients of liver abscess from northern India. J Trop Med 2014: 142382.
-
3.
Cheng AC, Currie BJ, 2005. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 18: 383–416.
-
5.
Pal P, Ray S, Moulick A, Dey S, Jana A, Banerjee A, 2014. Liver abscess caused by Burkholderia pseudomallei in a young man: a case report and review of literature. World J Clin Cases 2: 604–607.
-
6.
Mukhopadhya A, Balaji V, Jesudason MV, Amte A, Jeyamani R, Kurian G, 2007. Isolated liver abscesses in melioidosis. Indian J Med Microbiol 25: 150–151.
-
7.
Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, Zuidema GD, 1996. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg 223: 600–609.
-
8.
Thrall JH, 2016. Trends and developments shaping the future of diagnostic medical imaging: 2015 annual oration in diagnostic radiology. Radiology 279: 660–666.
-
9.
Goldman L, 2012. Goldman’s Cecil Medicine: Expert Consult Premium Edition 24. Barnes & Noble. Available at: https://www.barnesandnoble.com/w/goldmans-cecil-medicine-lee-goldman/1101445576?type=eBook. Accessed March 28, 2018.
-
10.
Laopaiboon V, Chamadol N, Buttham H, Sukeepaisarnjareon W, 2009. CT findings of liver and splenic abscesses in melioidosis: comparison with those in non-melioidosis. J Med Assoc Thai 92: 1476–1484.
-
11.
Apisarnthanarak A, Apisarnthanarak P, Mundy LM, 2006. Computed tomography characteristics of Burkholderia pseudomallei liver abscess. Clin Infect Dis 42: 989–993.
-
12.
Ong SCL, Alemam MMM, Zakaria NA, Abdul Halim NA, 2017. Honeycomb and necklace signs in liver abscesses secondary to melioidosis. BMJ Case Rep 2017: 222342.
-
13.
Chong VH, 2006. Is a honeycomb appearance on computer tomography characteristic for Burkholderia pseudomallei liver abscess? Clin Infect Dis 43: 265–266.
-
14.
Mori N, Murakami K, 2017. Honeycomb liver abscess. IDCases 8: 66–67.
-
15.
Karaosmanoglu AD, Onur MR, Sahani DV, Tabari A, Karcaaltincaba M, 2016. Hepatobiliary tuberculosis: imaging findings. AJR Am J Roentgenol 207: 694–704.
-
16.
Kakkar C, Polnaya AM, Koteshwara P, Smiti S, Rajagopal KV, Arora A, 2015. Hepatic tuberculosis: a multimodality imaging review. Insights Imaging 6: 647–658.
-
17.
Muttarak M, Peh WC, Euathrongchit J, Lin SE, Tan AG, Lerttumnongtum P, Sivasomboon C, 2009. Spectrum of imaging findings in melioidosis. Br J Radiol 82: 514–521.
-
18.
Viera AJ, Garrett JM, 2005. Understanding interobserver agreement: the kappa statistic. Fam Med 37: 360–363.
-
19.
Princess I, Ebenezer R, Ramakrishnan N, Daniel AK, Nandini S, Thirunarayan MA, 2017. Melioidosis: an emerging infection with fatal outcomes. Indian J Crit Care Med 21: 397–400.
-
20.
Young A, Tacon C, Smith S, Reeves B, Wiseman G, Hanson J, 2017. Case report: fatal pediatric melioidosis despite optimal intensive care. Am J Trop Med Hyg 97: 1691–1694.
-
21.
Munckhof WJ, Mayo MJ, Scott I, Currie BJ, 2001. Fatal human melioidosis acquired in a subtropical Australian city. Am J Trop Med Hyg 65: 325–328.
-
22.
Dance D, 2014. Treatment and prophylaxis of melioidosis. Int J Antimicrob Agents 43: 310–318.
-
23.
Schweizer HP, 2012. Mechanisms of antibiotic resistance in Burkholderia pseudomallei: implications for treatment of melioidosis. Future Microbiol 7: 1389–1399.
-
24.
Apisarnthanarak P, Thairatananon A, Muangsomboon K, Lu DS, Mundy LM, Apisarnthanarak A, 2011. Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: a 7-year study. J Med Imaging Radiat Oncol 55: 176–182.
-
25.
Kjossev KT, Losanoff JE, 2005. Classification of hydatid liver cysts. J Gastroenterol Hepatol 20: 352–359.
-
26.
Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS, 2000. Hydatid disease: radiologic and pathologic features and complications. RadioGraphics 20: 795–817.
-
27.
Duman K, Girgin M, Hamcan S, 2016. Uncomplicated hydatid cysts of the liver: clinical presentation, diagnosis and treatment. J Gastrointest Dig Syst 6: 430.
-
28.
Zueter A, Yean CY, Abumarzouq M, Rahman ZA, Deris ZZ, Harun A, 2016. The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a north-eastern state of Malaysia: a fifteen-year review. BMC Infect Dis 16: 333.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1156 | 1049 | 64 |
| Full Text Views | 553 | 13 | 1 |
| PDF Downloads | 157 | 13 | 2 |
A Retrospective Case–Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess
Hannah L. Khiangte
Hannah L. Khiangte
Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India;
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Leena Robinson Vimala
Leena Robinson Vimala
Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India;
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Anu Eapen
Anu Eapen
Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India;
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Balaji Veeraraghavan
Balaji Veeraraghavan
Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India;
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Reka Karuppusami
Reka Karuppusami
Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
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Sridhar Gibikote
Sridhar Gibikote
Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India;
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Among pyogenic liver abscesses, melioid etiology is considered in endemic regions in the presence of known health or occupational risk factors. “Honeycomb sign,” used to describe an abscess with multiple internal septations dividing the abscess cavity into multiple loculations of comparable sizes on imaging, is a sensitive sign for melioid liver abscess. This is a retrospective case–control study investigating incidence, sensitivity, and specificity of “honeycomb sign” in melioid liver abscess, in a cohort of patients with culture-proven melioidosis infection. Abscesses ≥ 2 cm were analyzed for the honeycomb sign. P value < 0.05 was taken as statistically significant. Interobserver agreement was calculated between two radiologists for the presence of the sign, sensitivity, and specificity. A total of 40 abscesses were analyzed. Thirty-four abscesses (85%) manifested the honeycomb sign with interobserver agreement (kappa = 0.70 and 0.92). Sensitivity of the sign is 85% (95% confidence interval [CI]: 70–94%), specificity is 75% (95% CI: 59–87%), positive predictive value is 77% (95% CI: 62–88%), and negative predictive value is 83% (95% CI: 67–94%). If abscess size is ≥ 3 cm, the sensitivity is 91% (95% CI: 77–98%), specificity is 75% (95% CI: 59–87%), positive predictive value is 76% (95% CI: 61–88%), and negative predictive value is 91% (95% CI: 76–98%). Honeycomb sign is a novel imaging marker for melioid liver abscess. Increased awareness and recognition of this imaging feature has the potential to affect patient management.
Author Notes
Authors’ addresses: Hannah L. Khiangte, Leena Robinson Vimala, Anu Eapen, and Sridhar Gibikote, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, E-mails: hannahkhiangte@gmail.com, leenarv76@gmail.com, anuepn@yahoo.com, and gibikote@gmail.com. Balaji Veeraraghavan, Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India, E-mail: vbalaji@cmcvellore.ac.in. Reka Karuppusami, Department of Biostatistics, Christian Medical College and Hospital, Vellore, India, E-mail: reachreka28@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Mohsen AH, Green ST, Read RC, McKendrick MW, 2002. Liver abscess in adults: ten years experience in a UK centre. QJM 95: 797–802.
-
2.
Ghosh S, Sharma S, Gadpayle AK, Gupta HK, Mahajan RK, Sahoo R, Kumar N, 2014. Clinical, laboratory, and management profile in patients of liver abscess from northern India. J Trop Med 2014: 142382.
-
3.
Cheng AC, Currie BJ, 2005. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 18: 383–416.
-
5.
Pal P, Ray S, Moulick A, Dey S, Jana A, Banerjee A, 2014. Liver abscess caused by Burkholderia pseudomallei in a young man: a case report and review of literature. World J Clin Cases 2: 604–607.
-
6.
Mukhopadhya A, Balaji V, Jesudason MV, Amte A, Jeyamani R, Kurian G, 2007. Isolated liver abscesses in melioidosis. Indian J Med Microbiol 25: 150–151.
-
7.
Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, Zuidema GD, 1996. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg 223: 600–609.
-
8.
Thrall JH, 2016. Trends and developments shaping the future of diagnostic medical imaging: 2015 annual oration in diagnostic radiology. Radiology 279: 660–666.
-
9.
Goldman L, 2012. Goldman’s Cecil Medicine: Expert Consult Premium Edition 24. Barnes & Noble. Available at: https://www.barnesandnoble.com/w/goldmans-cecil-medicine-lee-goldman/1101445576?type=eBook. Accessed March 28, 2018.
-
10.
Laopaiboon V, Chamadol N, Buttham H, Sukeepaisarnjareon W, 2009. CT findings of liver and splenic abscesses in melioidosis: comparison with those in non-melioidosis. J Med Assoc Thai 92: 1476–1484.
-
11.
Apisarnthanarak A, Apisarnthanarak P, Mundy LM, 2006. Computed tomography characteristics of Burkholderia pseudomallei liver abscess. Clin Infect Dis 42: 989–993.
-
12.
Ong SCL, Alemam MMM, Zakaria NA, Abdul Halim NA, 2017. Honeycomb and necklace signs in liver abscesses secondary to melioidosis. BMJ Case Rep 2017: 222342.
-
13.
Chong VH, 2006. Is a honeycomb appearance on computer tomography characteristic for Burkholderia pseudomallei liver abscess? Clin Infect Dis 43: 265–266.
-
14.
Mori N, Murakami K, 2017. Honeycomb liver abscess. IDCases 8: 66–67.
-
15.
Karaosmanoglu AD, Onur MR, Sahani DV, Tabari A, Karcaaltincaba M, 2016. Hepatobiliary tuberculosis: imaging findings. AJR Am J Roentgenol 207: 694–704.
-
16.
Kakkar C, Polnaya AM, Koteshwara P, Smiti S, Rajagopal KV, Arora A, 2015. Hepatic tuberculosis: a multimodality imaging review. Insights Imaging 6: 647–658.
-
17.
Muttarak M, Peh WC, Euathrongchit J, Lin SE, Tan AG, Lerttumnongtum P, Sivasomboon C, 2009. Spectrum of imaging findings in melioidosis. Br J Radiol 82: 514–521.
-
18.
Viera AJ, Garrett JM, 2005. Understanding interobserver agreement: the kappa statistic. Fam Med 37: 360–363.
-
19.
Princess I, Ebenezer R, Ramakrishnan N, Daniel AK, Nandini S, Thirunarayan MA, 2017. Melioidosis: an emerging infection with fatal outcomes. Indian J Crit Care Med 21: 397–400.
-
20.
Young A, Tacon C, Smith S, Reeves B, Wiseman G, Hanson J, 2017. Case report: fatal pediatric melioidosis despite optimal intensive care. Am J Trop Med Hyg 97: 1691–1694.
-
21.
Munckhof WJ, Mayo MJ, Scott I, Currie BJ, 2001. Fatal human melioidosis acquired in a subtropical Australian city. Am J Trop Med Hyg 65: 325–328.
-
22.
Dance D, 2014. Treatment and prophylaxis of melioidosis. Int J Antimicrob Agents 43: 310–318.
-
23.
Schweizer HP, 2012. Mechanisms of antibiotic resistance in Burkholderia pseudomallei: implications for treatment of melioidosis. Future Microbiol 7: 1389–1399.
-
24.
Apisarnthanarak P, Thairatananon A, Muangsomboon K, Lu DS, Mundy LM, Apisarnthanarak A, 2011. Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: a 7-year study. J Med Imaging Radiat Oncol 55: 176–182.
-
25.
Kjossev KT, Losanoff JE, 2005. Classification of hydatid liver cysts. J Gastroenterol Hepatol 20: 352–359.
-
26.
Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS, 2000. Hydatid disease: radiologic and pathologic features and complications. RadioGraphics 20: 795–817.
-
27.
Duman K, Girgin M, Hamcan S, 2016. Uncomplicated hydatid cysts of the liver: clinical presentation, diagnosis and treatment. J Gastrointest Dig Syst 6: 430.
-
28.
Zueter A, Yean CY, Abumarzouq M, Rahman ZA, Deris ZZ, Harun A, 2016. The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a north-eastern state of Malaysia: a fifteen-year review. BMC Infect Dis 16: 333.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1156 | 1049 | 64 |
| Full Text Views | 553 | 13 | 1 |
| PDF Downloads | 157 | 13 | 2 |