Pyogenic liver abscess differential diagnosis: Difference between revisions
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|[[Amoebic liver abscess]] | |[[Amoebic 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]] | ||
| | | | ||
* 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 | ||
* [[ | * [[Seropositive]] | ||
* Right lobe is more frequently involved | * [[Right lobe of liver|Right lobe]] is more frequently involved | ||
|- | |- | ||
|[[Pyogenic liver abscess]] | |[[Pyogenic liver abscess]] | ||
| Line 67: | Line 67: | ||
* [[Anaerobic]] organisms | * [[Anaerobic]] organisms | ||
* [[Acid fast bacilli]] | * [[Acid fast bacilli]] | ||
| | | + | ||
| | | + | ||
| | | ++ | ||
| | | ++ | ||
| | | +/- | ||
| | | +++ | ||
| | | + | ||
(acute loss) | (acute loss) | ||
| | | + | ||
| | | | ||
| | | + | ||
|Pale/dark | |Pale/dark | ||
|[[Hypoalbuminemia]] | |[[Hypoalbuminemia]] | ||
( | (+++) | ||
| | |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 | ||
| Line 90: | Line 90: | ||
* 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|Candida species]]''<br>[[Aspergillus|Aspergillus species]] | |''[[Candida|Candida species]]''<br>[[Aspergillus|Aspergillus species]] | ||
| | | + | ||
| | | + | ||
| | | +/- | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | + | ||
| | | | ||
| | | | ||
|[[CT]] and [[ | |[[CT]] and [[Ultrasonography|US]] 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 | ||
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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]] | ||
|- | |- | ||
| Line 121: | Line 121: | ||
|[[Echinococcus granulosus]] | |[[Echinococcus granulosus]] | ||
| | | | ||
| | | + | ||
| | | | ||
| | | + | ||
| | | | ||
| | | + | ||
([[Obstructive jaundice]]) | ([[Obstructive jaundice]]) | ||
| | | + | ||
| | | + | ||
| | | | ||
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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 | ||
* [[Calcifications]] seen peripherally | * [[Calcification|Calcifications]] seen peripherally | ||
| | | | ||
* 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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*[[Alpha 1 antitrypsin deficiency]] | *[[Alpha 1 antitrypsin deficiency]] | ||
*[[Non alcoholic fatty liver disease]] | *[[Non alcoholic fatty liver disease]] | ||
| | | + | ||
| | | + | ||
(uncommon) | (uncommon) | ||
| | | | ||
| | | | ||
| | | + | ||
| | | + | ||
| | | ++ | ||
| | | | ||
| | | | ||
| | | ++ | ||
|Pale/Chalky | |Pale/Chalky | ||
| | | | ||
Revision as of 15:07, 31 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 | 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.