Amoebic liver abscess differential diagnosis: Difference between revisions
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| Line 33: | Line 33: | ||
! Pleuritic pain | ! Pleuritic pain | ||
|- | |- | ||
|Amoebic | |[[Amoebic | ||
liver abscess | liver abscess]] | ||
|Entamoeba | |[[Entamoeba | ||
histolytica | histolytica]] | ||
|✔✔✔ | |✔✔✔ | ||
|✔✔✔ | |✔✔✔ | ||
| Line 50: | Line 50: | ||
|✔ | |✔ | ||
| | | | ||
|Hypoalbuminemia | |[[Hypoalbuminemia]] | ||
(✔) | (✔) | ||
| | | | ||
* Ultrasound is the gold standard technique for diagnosing amoebic liver abscess | * Ultrasound is the gold standard technique for diagnosing [[amoebic liver abscess]] | ||
| | | | ||
* 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 | ||
| Line 80: | Line 80: | ||
|✔ | |✔ | ||
|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 larger [[abscess]] cavity | * 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 | ||
| Line 95: | Line 95: | ||
|- | |- | ||
|Fungal liver abscess | |Fungal liver abscess | ||
|Candida species | |''[[Candida|Candida species]]'' | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
| Line 115: | Line 115: | ||
| | | | ||
* 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]] | ||
| | | | ||
|✔ | |✔ | ||
| Line 136: | Line 136: | ||
|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 | ||
| Line 147: | Line 147: | ||
| | | | ||
* 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]] | ||
*Heamochromatosis | *[[Heamochromatosis]] | ||
*Alpha 1 antitrypsin deficiency | *[[Alpha 1 antitrypsin deficiency]] | ||
*Non alcoholic fatty liver disease | *[[Non alcoholic fatty liver disease]] | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
| Line 172: | Line 172: | ||
|Pale/Chalky | |Pale/Chalky | ||
| | | | ||
* High levels of AFP in serum | * High levels of [[alpha feto protein|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]] | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:52, 6 March 2017
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Amoebic liver abscess Microchapters |
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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, necrotic hepatoma, 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 | 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 | ✔ | ✔ | ✔/✘ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | CT and Us findings with four patterns of presentation:
|
| ||
| Echinococcal (hydatid) cyst | Echinococcus granulosus | ✔ | ✔ | ✔
(Obstructive jaundice) |
✔ | ✔ | 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
- ↑ 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.