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Case of the Month

October 2007

Patient Data: 7 year old girl

Clinical Info: Fever abdominal pain and an enlarged liver and spleen

Transverse image of an enlarged spleen with multiple hypoechoic round lesions

Longitudinal image of an enlarged spleen with multiple hypoechoic round lesions

The lesions are not vascularized

The liver is also inhomogeneous with multiple hypoechoic lesions

Left liver lobe with 2 hypoechoic lesions longitudinal view

Left liver lobe with hypoechoic lesions transverse view The lesions in the liver and the spleen are multiple hepatic and splenic abscesses. The girl had serological evidence of cat scratch disease. Cat scratch disease is an infection caused by a gram-negative bacillus known as Bartonella Henselae. Cat scratch disease is not uncommon, but hepatosplenic disease occurs in only 0.3-0.7% of the patients. Long term antibiotic treatment is the treatment of choice. After a few months the ultrasound examination was repeated. The liver lesions were nearly all gone. The splenic lesions had diminished in size.

After treatment the lesions diminish in size

Only a solitairy liver lesion can be identified

For more splenic or liver abscesses see

Kusuhara K, Nakao F, Saito M, Nakamura K, Ieiri S, Taguchi T, Hara T. Pyogenic splenic abscess in an infant with serological evidence of cat scratch disease.
Eur J Pediatr. 2006 Dec 22;

Dunn MW, Berkowitz FE, Miller JJ, Snitzer JA. Hepatosplenic cat-scratch disease and abdominal pain.
Pediatr Infect Dis J. 1997 Mar;16(3):269-72.

Rizkallah MF, Meyer L, Ayoub EM. Hepatic and splenic abscesses in cat-scratch disease. Pediatr Infect Dis J. 1988 Mar;7(3):191-5.

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