Liver%20abscess Diagnosis

• Diagnosis of liver abscess is made by history, physical examination, imaging, & culture of abscess material

• Inquire about patient’s medical history, recent procedures, place of residence, history of travel

• Fever, jaundice
• Tender, enlarged liver w/ or w/o a palpable mass
• Epigastric tenderness may be found in patients w/ left hepatic lobe abscess
• Decreased breath sounds on the base of the right lung w/ signs of atelectasis & pleural effusion
• Pleural or hepatic friction rub
• Rare: Ascites, splenomegaly

Cultures

Culture of Abscess Fluid

• Aspirated abscess fluid should be Gram stained & cultured to establish the microbiologic diagnosis
  
  • Other causes of liver abscess are amoeba & fungi, most commonly Candida species

• Culture from drains is not recommended due to contamination w/ skin flora

Blood Culture

• Positive in about half of patients w/ liver abscess
• Samples should be taken for both aerobic & anaerobic cultures
• Results of blood & abscess fluid cultures are not always concordant

Other Laboratory Examinations

Tests to Detect Amoebic Infection

• Enzyme-linked immunosorbent assay (ELISA) should be done to detect E histolytica in patients who are from endemic areas or have traveled to endemic areas
• Indirect hemagglutination may also be used in serologic diagnosis, but is less sensitive than enzyme-linked immunosorbent assay (ELISA)
• Other serologic tests include indirect immunofluorescence & Latex agglutination technique
• Fecal exam to detect E histolytica trophozoites & cysts

Liver Function Tests

• Alkaline phosphatase elevation is seen in two-thirds of patients & tends to deviate from the normal range more than the other liver function tests
• Hypoalbuminemia is also common
• Abnormalities in alanine aminotransferase (ALT), aspartate aminotransferase (AST) & bilirubin levels are variable

Complete Blood Count

• Leukocytosis w/ neutrophil predominance
• May reveal anemia of chronic disease

• Imaging of the liver is essential in making the diagnosis of liver abscess
• Ultrasound & computed tomography (CT) scan are the initial imaging procedures of choice
• Cannot distinguish pyogenic liver abscess from amoebic abscess

Ultrasound

• Inexpensive & accurate
• Recommended for patients w/ suspected biliary disorders & those who cannot be exposed to radiation or receive contrast dyes
• Useful for guiding needle aspiration of abscess
• Abscesses are seen as hypoechoic masses w/ irregularly shaped borders, w/ or w/o internal septations

Computed Tomography (CT)  Scan

• More sensitive than ultrasound
  
  • Can detect abscesses smaller than 1 cm better than ultrasound
• Superior to ultrasound for guiding complex drainage procedures
•  Can be used to assess the relationship of an abscess to adjacent structures, to evaluate for a concurrent disorder in the abdomen & pelvis & to detect gas in the abscess
•  Abscesses are seen as hypodense structures w/ or w/o a rim of contrast enhancement

Chest X-ray

• About half of patients will have basilar atelectasis, elevation of the right hemidiaphragm, & right pleural effusion
• May initially lead to a wrong diagnosis of pneumonia or pleural disease

• Monitor patient’s clinical response & follow-up imaging studies to decide duration of antibiotic therapy & need for other interventions
  
  • May follow temperature, white blood cell count, & serum C-reactive protein (CRP)
  • Resolution of abnormalities on imaging lag behind clinical or lab marker improvement

• Surgical drainage may be needed in a patient w/ failed percutaneous drainage, persistent jaundice, renal impairment, multiloculated abscess