If the liver and other tissues show multiple random lesions, how did bacteria reach these organs?

• A. Through portal circulation
• B. Through biliary tree
• C. Systemic hematogenous spread
• D. Through lymphatic spread

Answer: (C)

When bacteria reach distant organs in multiple random spots, it points to bacteremia with hematogenous spread. Bacteria circulating in the bloodstream can lodge in the capillary beds of many organs, seeding multiple sites at once. The liver is a common recipient because its extensive sinusoids act as a filter for blood, but seeds can also establish in other tissues, producing scattered microabscesses.

If the spread were through the portal circulation, you’d expect the liver to be primarily affected due to drain from the gut, with a more localized pattern rather than widespread random lesions in multiple organs. Spread via the biliary tree would follow biliary tract infection patterns, often affecting the liver along the biliary system rather than across different organs. Lymphatic spread tends to involve lymph nodes and along lymphatic channels, not a broad distribution of lesions in various organs.