Liver candidiasis

The liver is frequently involved secondary to hematogenous spread of mycotic infections in other organs, most oten the lungs. Patients are generally immunocompromised particularly those receiving chemotherapy for hematological malignancies.

Clinical presentation

The clinical characteristic is usually persistent fever in a neutropenic patient

Ultrasound features

“Wheel within a wheel”: peripheral hypoechoic zone with inner echogenic wheel and central hypoechoic nidus. The central nidus represents focal necrosis in which fungal elements are found. This is seen early in the disease.
Bull's-eye: 1- to 4-cm lesion with hyperechoic center and hypoechoic rim. It is present when neutrophil counts return to normal. The echogenic center contains inflammatory cells
Uniformly hypoechoic: most common, corresponding to progressive fibrosis
Echogenic: variable calcification, representing scar formation

bull-eye appearence — **Liver candidiasis.** Figure 1: “Bull's-eye”. *The liver showed multiple masses. This magniied view shows a thick, echogenic rim and a thin, hypoechoic inner rim with a dense echogenic nidus.* Figure 2: Uniformly hypoechoic pattern. *Multiple hypoechoic hepatic lesions are present in this young patient with acute myelogenous leukemia*. Figure 3: Echogenic pattern after medical therapy. *Small calciied lesion (arrow) is visualized in another immunocompromised patient*.

Uniformly hypoechoic pattern of liver parenchyma — **Liver candidiasis.** Figure 1: “Bull's-eye”. *The liver showed multiple masses. This magniied view shows a thick, echogenic rim and a thin, hypoechoic inner rim with a dense echogenic nidus.* Figure 2: Uniformly hypoechoic pattern. *Multiple hypoechoic hepatic lesions are present in this young patient with acute myelogenous leukemia*. Figure 3: Echogenic pattern after medical therapy. *Small calciied lesion (arrow) is visualized in another immunocompromised patient*.