Pyogenic liver abscess differential diagnosis: Difference between revisions
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| Line 34: | Line 34: | ||
! Pleuritic pain | ! Pleuritic pain | ||
|- | |- | ||
|Amoebic | |[[Amoebic liver abscess]] | ||
liver abscess | |[[Entamoeba histolytica]] | ||
|Entamoeba | |||
histolytica | |||
|✔✔✔ | |✔✔✔ | ||
|✔✔✔ | |✔✔✔ | ||
| Line 51: | Line 49: | ||
|✔ | |✔ | ||
| | | | ||
|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 63: | Line 61: | ||
* Right lobe is more frequently involved | * Right lobe is more frequently involved | ||
|- | |- | ||
|Pyogenic liver abscess | |[[Pyogenic liver abscess]] | ||
|Bacteria | |Bacteria | ||
* Gram-positive aerobes | * Gram-positive aerobes | ||
| Line 81: | Line 79: | ||
|✔ | |✔ | ||
|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 96: | Line 94: | ||
|- | |- | ||
|Fungal liver abscess | |Fungal liver abscess | ||
|Candida species | |''[[Candida|Candida species]]''<br>[[Aspergillus|Aspergillus species]] | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
| Line 116: | Line 114: | ||
| | | | ||
* 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 137: | Line 135: | ||
|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 148: | Line 146: | ||
| | | | ||
* 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 173: | Line 171: | ||
|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]] | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 18:21, 6 March 2017
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Pyogenic liver abscess Microchapters |
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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 | ✔ | ✔ | ✔
(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
- ↑ 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.