Liver abscess:

Liver  abscesses are  localised  collections of necrotic inflammatory tissue caused by bacteria (polymicrobial ,pyogenic), parasite or protozoa( E histolytica, amoebic-producing  anchovy  paste appearance of the  contents) , helminiths and  fungal agents.  Infection elsewhere such as  abdominal sepsis are common source. Liver abscess  is  common in  immunocompromised and diabetics. About 15% of patients with, HIV / AIDS ,elderly, post  chemotherapy / transplant recipients and malignancy  might have liver abscess. Hepatic trauma with necrosis may also leads to  liver abscess. A large group of liver abscess may be due to  unknown cause (cryptogenic ).

Clinical presentation

The typical presentation is one of right upper quadrant pain, fever and jaundice (in some cases). Anorexia, malaise and weight loss are also frequently seen. Depending on the immune status of the patient, and the organism involved, presentation may be sudden  orgradual.

Radiographic features

As a general rule, bacterial and fungal abscesses are often multiple, whereas amoebic abscesses are more frequently single.  Amoebic abscesses are more common in a sub-diaphragmatic location and are more likely to spread through the diaphragm and into the chest. A plain abdominal radiograph may reveal  evaluating right lobe of diaphragm. Other findings may be gas within the abscess or biliary tree (pneumobilia) and right sided pleural effusion

Ultrasound : Liver abscesses are typically poorly demarcated with a variable appearance, ranging from predominantly hypoechoic (with some internal echoes ) to hyperechoic. Gas bubbles may also be seen. Liver abscesses on CT is variable, in general they appear as peripherally enhancing well outlined wall and  centrally low density lesions . Occasionally they appear solid, or contain gas.

Treatment and prognosis

Medical antimicrobial (Pyogenic) and anti protozoal (amoebic) therapy is required in all cases, and sometimes suffices if abscesses are small.
Percutaneous drainage of hepatic abscesses  can be performed either under ultrasound or CT guidance when the abscess is small ,unilocular with thick wall .
Surgery is the definitive strategy which offers adequate drainage,debribement and biopsy of the abscess wall. Additionally, the source of the abscess may be detected and its  surgical treatment (if needed) may be done at the same time.
Prognosis is highly variable, depending of not only the organism involved and size of the abscess, but also the co-morbidities present.


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