To investigate the application value of intracavitary contrast-enhanced ultrasound (IC-CEUS) in liver abscess with inadequate drainage.

Clinical data of 18 patients with liver abscess who underwent ultrasound-guided drainage and were suspicious of inadequate drainage in the Third Affiliated Hospital of Sun Yat-sen University between March 2011 and December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 13 cases were males and 5 females, aged 9-78 years old with a median age of 48 years old. All patients underwent conventional ultrasound-guided puncture and drainage of the liver abscess. Real-time IC-CEUS was performed by injection of contrast agent SonoVue through the drainage tube when inadequate drainage was suspected by clinical observation and conventional ultrasound examination. The position of drainage tube, the scope and communication of the liver abscess cavity were observed.

The position of drainage tube was accurately indicated by IC-CEUS in all the patients. The drainage tube was properly located in 13 cases, migrated in 3 and dislocated in 2. The liver abscess cavity was still present in 10 cases and basically absent in 3. Conventional ultrasound examination only found the drainage tube was properly located in 1 case and the liver abscess cavity remained present in 6. The position of drainage tube was adjusted for 3 cases with drainage tube migration, the drainage tube was re-inserted for 2 cases with drainage tube dislocation, and then IC-CEUS indicated that the drainage tube was located in the liver abscess cavity. The drainage tube was extubated for 3 cases with liver abscess cavity disappearance.

Compared with conventional ultrasound examination, IC-CEUS can provide accurate information of the drainage tube and liver abscess cavity. IC-CEUS can serve as a pivotal imaging approach for clinical observation, treatment and follow-up of the liver abscess patients with catheterization drainage.