IS Case 106: Pyogenic Hepatic Abscess

Scott Mooney, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

Patient is a 79-year-old male with a two week history of right upper quadrant pain and fever, elevated LFT's and WBC count.

Findings

Irregular low attenuation lesion in the right hepatic lobe with peripheral enhancement.

Figures 1 and 2 demonstrate a low attenuation lesion in the right hepatic lobe with peripheral enhancement. The lesion has irregular margins and multiple loculation.

Diagnosis

Pyogenic Hepatic Abscess

Discussion

A pyogenic abscess is a common manifestation of bacterial infection in the liver. Other infections involving the liver include an amebic abscess, echinococcal cyst, schistosomiasis, clonorchis, fungal and viral. E. coli is the most common pyogenic organism. Bacterial infection can originate from hematogenous or cryptogenic sources, ascending cholangitis, or superinfection of necrotic tissue. Clinical symptoms seen are malaise, fever, and abdominal pain.

The CT appearance of a pyogenic abscess is variable, but most commonly has a low attenuation centrally with some enhancement peripherally. Larger abscesses can have more atypical appearances due to debris and multiple loculations. Most often there is a single lesion, however there can be multiple abscesses. A miliary pattern of infection may be present in patients with septicemia, however, the spleen is also usually involved. Abscess formation is more common in the right lobe. Gas may be present within the abscess, but is seen in less than 20% of cases.

Treatment of pyogenic abscesses includes percutaneous drainage and antibiotics. Drainage may be deferred in smaller abscesses (< 5cm). Echinococcal infection should be excluded prior to aspiration or catheter placement as an anaphylactic reaction could develop.

References

  1. Halvorsen RA, Korobkin M, Foster WL, Silverman PM, Thompson WM. he variable CT appearance of hepatic abscesses. AJR Am J Roentgenol. 1984 May;142(5):941-6. [PMID: 6372412 ]
  2. Mathieu D, Vasile N, Fagniez PL, Segui S, Grably D, Lardé D. Dynamic CT features of hepatic abscesses. Radiology. 1985 Mar;154(3):749-52. [PMID: 3969480]
  3. Mortele KJ, Segatto E, Ros PR. The infected liver: radiologic-pathologic correlation. Radiographics. 2004 Jul-Aug;24(4):937-55. [PMID: 15256619]

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