Amoebic liver abscess differential diagnosis

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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:

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)	✔	✔	✔				More ill appearing than pyogenic abscess More fever than pyogenic Needle aspiration: Fluid from an ALA is odorless,reddish brown anchovy paste
Pyogenic liver abscess	Bacteria Gram-positive aerobes Gram-negative enterics Anaerobic organisms Acid fast bacilli	✔	✔		✔	✔	✔	✔ (acute loss)	✔	✔	✔	Pale/dark
Fungal liver abscess	Candida species	✔	✔		✔	✔	✔	✔	✔	✔	✔
Echinococcal (hydatid) cyst	Echinococcus granulosus
Malignancy (Hepatocellular carcinoma/Metastasis)	Hepatitis B and C Aflatoxins Alcohol Heamochromatosis Alpha 1 antitrypsin deficiency Non alcoholic fatty liver disease