A Retrospective Case–Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess

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.