Pyogenic liver abscess differential diagnosis: Difference between revisions
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(✔) | (✔) | ||
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* Ultrasound is the gold standard technique for diagnosing [[amoebic liver abscess]] | * [[Ultrasound]] is the gold standard technique for diagnosing [[amoebic liver abscess]] | ||
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* Respond well to [[chemotherapy]] and rarely require drainage | * Respond 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 | * [[Sero-positive]] | ||
* Right lobe is more frequently involved | * Right lobe is more frequently involved | ||
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|[[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]] | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
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(✔✔✔) | (✔✔✔) | ||
|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 larger [[abscess]] cavity | * Aggregation of multiple low attenuation [[liver]] lesions in a localized area to form a solitary larger [[abscess]] cavity | ||
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* Medical-surgical approach is indicated | * Medical-surgical approach is indicated | ||
* More common in developed countries | * More common in developed countries | ||
* Culture positive and sero-negative | * Culture positive and [[sero-negative]] | ||
* Both lobes are commonly involved | * Both lobes are commonly involved | ||
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* 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 | ||
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* 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]] | ||
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|[[hydatid cyst|Echinococcal (hydatid) cyst]] | |[[hydatid cyst|Echinococcal (hydatid) cyst]] | ||
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(Obstructive jaundice) | ([[Obstructive jaundice]]) | ||
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|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 | ||
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* Cystic to solid-appearing pseudotumors | * Cystic to solid-appearing pseudotumors | ||
* Water lily sign | * Water lily sign | ||
* Calcifications seen peripherally | * [[Calcifications]] seen peripherally | ||
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* Blood or liquid from the ruptured cyst may be coughed up | * Blood or liquid from the ruptured cyst may be coughed up | ||
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* High levels of [[alpha-fetoprotein|AFP]] in serum | * High levels of [[alpha-fetoprotein|AFP]] in serum | ||
* Abnormal liver function | * Abnormal [[liver function test]]s | ||
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* [[Liver biopsy]] | * [[Liver biopsy]] | ||
Revision as of 21:38, 7 March 2017
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Pyogenic liver abscess Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pyogenic liver abscess differential diagnosis On the Web |
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American Roentgen Ray Society Images of Pyogenic liver abscess differential diagnosis |
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Risk calculators and risk factors for Pyogenic 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
Pyogenic liver abscess must be differentiated from other diseases with similar presentation such as amoebic liver abscess, fungal liver abscess, echinococcal (hydatid) cyst and malignancy (Hepatocellular carcinoma or metastasis).[1][2][3][4]
Differential Diagnosis
Pyogenic liver abscess must be differentiated from:[1][2][3][4][5][6][7][8][9][10]
| Disease | Causes | symptoms | Lab Findings | Imaging Findings | Other Findings | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fever | Pain | cough | Hepatomegaly | Jaundice | Weight loss | Anorexia | Diarrhoea
or Dysentry |
Nausea and
vomiting |
Stool | ||||||
| Abdominal pain
(right upper quadrant 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 Us 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
(Hepatocellular carcinoma/Metastasis) |
✔ | ✔
(uncommon) |
✔ | ✔ | ✔✔ | ✔✔ | Pale/Chalky |
|
Other symptoms: | ||||||
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 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.