Typically refers to hepatic Candida abscesses in immunocompromised patients

Multiple small, hypoechoic lesions throughout liver (most common pattern)

Target sign (hyperechoic center with hypoechoic halo) or bull’s-eye configuration

Wheel within wheel pattern may be present in larger fungal lesions

Multiple small, hyperechoic foci throughout liver (occurs in later stages)

Lesions may resolve completely or calcify after successful treatment

Similar lesions may be found in spleen

Simple cysts

Necrotic metastases

Hepatic lymphoma

Sarcoidosis

Biliary hamartomas

Fungal infection: Most commonly Candida albicans but may also include Cryptococcus , histoplasmosis, mucormycosis, Aspergillus

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  Occur more commonly in immunocompromised patients (leukemia, lymphoma, AIDS/post transplant)

Pyogenic infections can appear similarly in patients with GI or biliary tract infection

Rule out other causes of multiple liver lesions, such as hepatic cysts, hepatic lymphoma, metastases, sarcoidosis

Liver biopsy with culture often necessary to verify lesions are due to fungal infection