Amoebic liver abscess differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Amoebic liver abscess must be differentiated from other diseases that cause [[fever]], abdominal pain, [[cough]], [[jaundice]], [[hepatomegaly]], [[anorexia]], [[nausea]], [[vomiting]], and pale or dark stools such as [[pyogenic liver abscess]], [[liver abscess|fungal liver abscess]] | Amoebic liver abscess must be differentiated from other diseases that cause [[fever]], [[abdominal pain]], [[cough]], [[jaundice]], [[hepatomegaly]], [[anorexia]], [[nausea]], [[vomiting]], and [[stool|pale or dark stools]] such as [[pyogenic liver abscess]], [[liver abscess|fungal liver abscess]], [[echinococcal cyst]], and [[hepatocellular carcinoma]]. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Amoebic liver abscess must be differentiated from:<ref name="pmid9834333">{{cite journal| author=Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA| title=Fungal hepatic abscesses: Characterization and management. | journal=J Gastrointest Surg | year= 1997 | volume= 1 | issue= 1 | pages= 78-84 | pmid=9834333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834333 }} </ref> | <small> | ||
Amoebic liver abscess must be differentiated from:<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463 }} </ref><ref name="pmid5054724">{{cite journal| author=Barbour GL, Juniper K| title=A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients. | journal=Am J Med | year= 1972 | volume= 53 | issue= 3 | pages= 323-34 | pmid=5054724 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5054724 }} </ref><ref name="pmid3316923">{{cite journal| author=Barnes PF, De Cock KM, Reynolds TN, Ralls PW| title=A comparison of amebic and pyogenic abscess of the liver. | journal=Medicine (Baltimore) | year= 1987 | volume= 66 | issue= 6 | pages= 472-83 | pmid=3316923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3316923 }} </ref><ref name="pmid3945889">{{cite journal| author=Conter RL, Pitt HA, Tompkins RK, Longmire WP| title=Differentiation of pyogenic from amebic hepatic abscesses. | journal=Surg Gynecol Obstet | year= 1986 | volume= 162 | issue= 2 | pages= 114-20 | pmid=3945889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3945889 }} </ref><ref name="pmid9834333">{{cite journal| author=Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA| title=Fungal hepatic abscesses: Characterization and management. | journal=J Gastrointest Surg | year= 1997 | volume= 1 | issue= 1 | pages= 78-84 | pmid=9834333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834333 }} </ref><ref name="pmid3275982">{{cite journal| author=Pastakia B, Shawker TH, Thaler M, O'Leary T, Pizzo PA| title=Hepatosplenic candidiasis: wheels within wheels. | journal=Radiology | year= 1988 | volume= 166 | issue= 2 | pages= 417-21 | pmid=3275982 | doi=10.1148/radiology.166.2.3275982 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3275982 }} </ref><ref name="pmid11452064">{{cite journal| author=Mortelé KJ, Ros PR| title=Cystic focal liver lesions in the adult: differential CT and MR imaging features. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 895-910 | pmid=11452064 | doi=10.1148/radiographics.21.4.g01jl16895 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452064 }} </ref><ref name="pmid7668917">{{cite journal| author=Suwan Z| title=Sonographic findings in hydatid disease of the liver: comparison with other imaging methods. | journal=Ann Trop Med Parasitol | year= 1995 | volume= 89 | issue= 3 | pages= 261-9 | pmid=7668917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7668917 }} </ref><ref name="pmid3047423">{{cite journal| author=Esfahani F, Rooholamini SA, Vessal K| title=Ultrasonography of hepatic hydatid cysts: new diagnostic signs. | journal=J Ultrasound Med | year= 1988 | volume= 7 | issue= 8 | pages= 443-50 | pmid=3047423 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3047423 }} </ref><ref name="pmid7225721">{{cite journal| author=Niron EA, Ozer H| title=Ultrasound appearances of liver hydatid disease. | journal=Br J Radiol | year= 1981 | volume= 54 | issue= 640 | pages= 335-8 | pmid=7225721 | doi=10.1259/0007-1285-54-640-335 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7225721 }} </ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan="3" |Disease | ! rowspan="3" |Disease | ||
! rowspan="3" |Causes | ! rowspan="3" |Causes | ||
! colspan="11" | | ! colspan="11"|Signs and Symptoms | ||
! rowspan="3" | | ! rowspan="3" |Laboratory Findings | ||
! rowspan="3" |Imaging Findings | ! rowspan="3" |Imaging Findings | ||
! rowspan="3" |Other Findings | ! rowspan="3" |Other Findings | ||
|- | |- | ||
! rowspan="2" | Fever | ! rowspan="2" | [[Fever]] | ||
! colspan="2" | Pain | ! colspan="2" | Pain | ||
! rowspan="2" | cough | ! rowspan="2" | [[Cough (patient information)|cough]] | ||
! rowspan="2" | Hepatomegaly | ! rowspan="2" | [[Hepatomegaly]] | ||
! rowspan="2" | Jaundice | ! rowspan="2" | [[Jaundice]] | ||
! rowspan="2" | Weight loss | ! rowspan="2" | [[Weight loss]] | ||
! rowspan="2" | Anorexia | ! rowspan="2" | [[Anorexia]] | ||
! rowspan="2" | Diarrhoea | ! rowspan="2" | [[Diarrhoea]] | ||
or Dysentry | or [[Dysentry]] | ||
! rowspan="2" | Nausea and | ! rowspan="2" | [[Nausea]] and | ||
vomiting | [[vomiting]] | ||
! rowspan="2" | Stool | ! rowspan="2" | [[Stool]] | ||
|- | |- | ||
! Abdominal pain | ! [[Abdominal pain]] | ||
(right upper quadrant pain) | ([[right upper quadrant pain]]) | ||
! Pleuritic pain | ! [[Pleuritic pain]] | ||
|- | |- | ||
|Amoebic | |[[Amoebic liver abscess]] | ||
liver abscess | |[[Entamoeba histolytica]] | ||
|Entamoeba | | +++ | ||
histolytica | | +++ | ||
| | | +/- | ||
| | | + | ||
| | | ++/- | ||
| | | + | ||
| | |||
| | |||
(late stages) | (late stages) | ||
| | | + | ||
(late stages) | (late stages) | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | | ||
|Hypoalbuminemia | |[[Hypoalbuminemia]] | ||
( | (+) | ||
| | | | ||
* Ultrasound is the gold standard technique for diagnosing amoebic liver abscess | * [[Ultrasound]] is the [[Gold standard (test)|gold standard]] technique for diagnosing [[amoebic liver abscess]] | ||
| | | | ||
* | * Responds well to [[chemotherapy]] and rarely require drainage | ||
* Marked male predominance | * Marked male predominance | ||
* More common in developing countries | * More common in developing countries | ||
* Sero-positive | * [[Seropositive|Sero-positive]] | ||
* Right lobe is more frequently involved | * [[Right lobe of liver|Right lobe]] is more frequently involved | ||
|- | |- | ||
|Pyogenic liver abscess | |[[Pyogenic liver abscess]] | ||
|Bacteria | |Bacteria | ||
* Gram-positive aerobes | * [[Gram-positive]] [[aerobes]] | ||
* Gram-negative enterics | * [[Gram-negative]] enterics | ||
* Anaerobic organisms | * [[Anaerobic]] organisms | ||
* Acid fast bacilli | * [[Acid-fast bacilli]] | ||
| | | + | ||
| | | + | ||
| | | ++ | ||
| | | ++ | ||
| | | +/- | ||
| | | +++ | ||
| | | + | ||
(acute loss) | (acute loss) | ||
| | | + | ||
| | | | ||
| | | + | ||
|Pale/dark | |Pale/dark | ||
|Hypoalbuminemia | |[[Hypoalbuminemia]] | ||
( | (+++) | ||
|Cluster sign | |Cluster sign | ||
* CT scan shows cluster sign | * [[CT scan]] shows cluster sign | ||
* Aggregation of multiple low attenuation liver lesions in a localized area to form a solitary | * Aggregation of multiple low attenuation [[liver]] lesions in a localized area to form a solitary larger [[abscess]] cavity | ||
| | | | ||
* Abnormal pulmonary findings | * Abnormal pulmonary findings | ||
* Diabetes mellitus increases the risk | * [[Diabetes mellitus]] increases the risk | ||
* Medical-surgical approach is indicated | * Medical-surgical approach is indicated | ||
* More common in developed countries | * More common in developed countries | ||
* Culture positive and | * Culture positive and [[seronegative]] | ||
* Both lobes are commonly involved | * Both lobes are commonly involved | ||
|- | |- | ||
|Fungal liver abscess | |Fungal liver abscess | ||
|Candida species | |''[[Candida|Candida species]]''<br>[[Aspergillus|Aspergillus species]] | ||
| | | + | ||
| | | + | ||
| | | +- | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | | ||
| | | | ||
|CT and | |[[CT]] and [[Ultrasonogram|USG]] findings with four patterns of presentation: | ||
* Wheel-within-a-wheel pattern | * Wheel-within-a-wheel pattern | ||
* Bull’s-eye configuration pattern | * Bull’s-eye configuration pattern | ||
* Uniformly hypoechoic nodule | * Uniformly hypoechoic nodule | ||
* | * Echogenic foci with variable degrees of posterior acoustic shadowing | ||
| | | | ||
* Less common | * Less common | ||
* Pure fungal abscess or associated with pyogenic abscess | * Pure fungal abscess or associated with [[pyogenic abscess]] | ||
* Candida and Aspergillus are commonly found in the culture of aspirated pus | * [[Candida]] and [[Aspergillus]] are commonly found in the culture of aspirated pus | ||
* Associated with underlying malignancy or DM | * Associated with underlying [[malignancy]] or [[DM]] | ||
|- | |- | ||
|Echinococcal (hydatid) cyst | |[[hydatid cyst|Echinococcal (hydatid) cyst]] | ||
|Echinococcus granulosus | |[[Echinococcus granulosus]] | ||
| | | | ||
| | | + | ||
| | | | ||
| | | + | ||
| | | | ||
| | | + | ||
(Obstructive jaundice) | ([[Obstructive jaundice]]) | ||
| | | + | ||
| | | + | ||
| | | | ||
| | | | ||
| | | | ||
|Histology: Hydatid cyst with three layers | |Histology: [[Hydatid cyst]] with three layers | ||
a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue | a.The outer pericyst, which corresponds with compressed and fibrosed [[liver]] tissue | ||
b.The endocyst, an inner germinal layer | b.The endocyst, an inner germinal layer | ||
c.The ectocyst, a thin, translucent interleaved membrane | c.The ectocyst, a thin, translucent interleaved membrane | ||
|Ultrasound: | |[[Ultrasound]]: | ||
* Cystic to solid-appearing pseudotumors | * [[Cystic]] to [[solid]]-appearing pseudotumors | ||
* Water lily sign | * Water lily sign | ||
* | * [[Calcification]]s seen peripherally | ||
| | | | ||
* Blood or liquid from the ruptured cyst may be coughed up | * Blood or liquid from the ruptured cyst may be coughed up | ||
* Pruritis | * [[Pruritis]] | ||
|- | |- | ||
|Malignancy | |[[Malignancy]] | ||
(Hepatocellular carcinoma/Metastasis) | ([[Hepatocellular carcinoma]]/[[Metastasis]]) | ||
| | | | ||
*Hepatitis B and C | *[[Hepatitis B]] and [[hapatitis C|C]] | ||
*Aflatoxins | *[[Aflatoxins]] | ||
*Alcohol | *[[Alcohol]] | ||
* | *[[Hemochromatosis]] | ||
*Alpha 1 antitrypsin deficiency | *[[Alpha 1 antitrypsin deficiency]] | ||
* | *[[Nonalcoholic fatty liver disease]] | ||
| | | + | ||
| | | + | ||
(uncommon) | (uncommon) | ||
| | | | ||
| | | | ||
| | | + | ||
| | | + | ||
| | | ++ | ||
| | | | ||
| | | | ||
| | | ++ | ||
|Pale/Chalky | |Pale/Chalky | ||
| | | | ||
* High levels of AFP in serum | * High levels of [[alpha-fetoprotein|AFP]] in [[serum]] | ||
* Abnormal liver function tests | * Abnormal [[liver function tests]] | ||
| | | | ||
* Liver biopsy | * [[Liver biopsy]] | ||
|Other symptoms: | |Other symptoms: | ||
* Splenomegaly | * [[Splenomegaly]] | ||
* Variceal bleeding | * [[Variceal bleeding]] | ||
* Ascites | * [[Ascites]] | ||
* Spider nevi | * [[Spider nevi]] | ||
* Asterixis | * [[Asterixis]] | ||
|} | |} | ||
</small> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Infectious disease]] | |||
[[Category:Hepatology]] | |||
Latest revision as of 20:23, 29 July 2020
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Amoebic liver abscess Microchapters |
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Case Studies |
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Amoebic liver abscess differential diagnosis On the Web |
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American Roentgen Ray Society Images of Amoebic liver abscess differential diagnosis |
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Risk calculators and risk factors for Amoebic liver abscess differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
Amoebic liver abscess must be differentiated from other diseases that cause fever, abdominal pain, cough, jaundice, hepatomegaly, anorexia, nausea, vomiting, and pale or dark stools such as pyogenic liver abscess, fungal liver abscess, echinococcal cyst, and hepatocellular carcinoma.
Differential Diagnosis
Amoebic liver abscess must be differentiated from:[1][2][3][4][5][6][7][8][9][10]
| Disease | Causes | Signs and Symptoms | Laboratory Findings | Imaging Findings | Other Findings | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fever | Pain | cough | Hepatomegaly | Jaundice | Weight loss | Anorexia | Diarrhoea
or Dysentry |
Nausea and | Stool | ||||||
| Abdominal pain | Pleuritic pain | ||||||||||||||
| Amoebic liver abscess | Entamoeba histolytica | +++ | +++ | +/- | + | ++/- | +
(late stages) |
+
(late stages) |
+ | + | + | Hypoalbuminemia
(+) |
|
| |
| Pyogenic liver abscess | Bacteria
|
+ | + | ++ | ++ | +/- | +++ | +
(acute loss) |
+ | + | Pale/dark | Hypoalbuminemia
(+++) |
Cluster sign |
| |
| Fungal liver abscess | Candida species Aspergillus species |
+ | + | +- | + | + | + | + | + | + | + | CT and USG findings with four patterns of presentation:
|
| ||
| Echinococcal (hydatid) cyst | Echinococcus granulosus | + | + | + | + | + | Histology: Hydatid cyst with three layers
a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue b.The endocyst, an inner germinal layer c.The ectocyst, a thin, translucent interleaved membrane |
Ultrasound:
|
| ||||||
| Malignancy | + | +
(uncommon) |
+ | + | ++ | ++ | Pale/Chalky |
|
Other symptoms: | ||||||
References
- ↑ Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA (2004). "Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases". Trop Med Int Health. 9 (6): 718–23. doi:10.1111/j.1365-3156.2004.01246.x. PMID 15189463.
- ↑ Barbour GL, Juniper K (1972). "A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients". Am J Med. 53 (3): 323–34. PMID 5054724.
- ↑ Barnes PF, De Cock KM, Reynolds TN, Ralls PW (1987). "A comparison of amebic and pyogenic abscess of the liver". Medicine (Baltimore). 66 (6): 472–83. PMID 3316923.
- ↑ Conter RL, Pitt HA, Tompkins RK, Longmire WP (1986). "Differentiation of pyogenic from amebic hepatic abscesses". Surg Gynecol Obstet. 162 (2): 114–20. PMID 3945889.
- ↑ Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA (1997). "Fungal hepatic abscesses: Characterization and management". J Gastrointest Surg. 1 (1): 78–84. PMID 9834333.
- ↑ Pastakia B, Shawker TH, Thaler M, O'Leary T, Pizzo PA (1988). "Hepatosplenic candidiasis: wheels within wheels". Radiology. 166 (2): 417–21. doi:10.1148/radiology.166.2.3275982. PMID 3275982.
- ↑ Mortelé KJ, Ros PR (2001). "Cystic focal liver lesions in the adult: differential CT and MR imaging features". Radiographics. 21 (4): 895–910. doi:10.1148/radiographics.21.4.g01jl16895. PMID 11452064.
- ↑ Suwan Z (1995). "Sonographic findings in hydatid disease of the liver: comparison with other imaging methods". Ann Trop Med Parasitol. 89 (3): 261–9. PMID 7668917.
- ↑ Esfahani F, Rooholamini SA, Vessal K (1988). "Ultrasonography of hepatic hydatid cysts: new diagnostic signs". J Ultrasound Med. 7 (8): 443–50. PMID 3047423.
- ↑ Niron EA, Ozer H (1981). "Ultrasound appearances of liver hydatid disease". Br J Radiol. 54 (640): 335–8. doi:10.1259/0007-1285-54-640-335. PMID 7225721.