Abstract
The imaging studies of 63 patients with hepatic abscess were evaluated to determine the sensitivity of specific imaging tests and define causes of false-negative test results. Computed tomography (CT) detected 57 of 59 (97%) separate episodes of hepatic abscess. The two false-negative CT examinations were in patients with a diffuse low-density pattern throughout the liver. The radionuclide (RN) examination detected 16 of 20 (80%) cases, missing abscesses less than 2 cm in diameter. Ultrasound detected 33 of 42 (79%) cases, missing abscesses in the dome of the liver, small abscesses, and 2 large early abscesses. For all three imaging modalities, a specific diagnosis of abscess was possible only in those patients in whom CT scans demonstrated abscess gas (15%). The results of the imaging studies were correlated with the patients' clinical condition and laboratory findings. Thirty-one percent of patients were afebrile while 23% had normal white blood cell counts. Thirteen percent had totally normal liver function tests. We conclude that the clinical absence of fever, leukocytosis, or elevated liver function tests does not permit exclusion of the diagnosis of hepatic abscess. A CT scan is highly specific in excluding the diagnosis of hepatic abscess in the absence of diffuse liver disease. In this retrospective study CT was the most sensitive imaging modality available for the detection of hepatic abscess.
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Altemeier WA: Pyogenic liver abscesses. In Schiff L Schiffer (eds):Disease of the Liver. Philadelphia: JB Lippincott, 1982, pp 1221–1238
Altemeier WA, Schowengerdt CG, Whiteley DH: Abscesses of the liver: surgical considerations.Arch Surg 101:258–266, 1970
Kandel G, Marcon NE: Pyogenic liver abscess: new concepts of an old disease.Am J Gastroenterol 79:65–71, 1984
Neoptolemos JP, Macpherson DS: Pyogenic liver abscess.Br J Hosp Med 26:47–55, 1981
Berger LA, Osborne DR: Treatment of pyogenic liver abscess by percutaneous needle aspiration.Lancet 1:132–134, 1982
Pitt HA, Zuida GD: Factors in influencing mortality in the treatment of pyogenic hepatic abscess.Surg Gynecol Obstet 140:228–234, 1975
Wintch RW, Reines HD, Rambo WM: Liver abscess: a changing entity.Am Surg 48:11–15, 1982
McDonald AP, Howard RJ: Pyogenic liver abscess.World J Surg 4:369–380, 1980
McDonald MI, Corey GR, Gallis HA, Durack DT: Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment with emphasis on percutaneous drainage.Medicine 63:291–302, 1984
Mueller PR, Simeone JF: Intra-abdominal abscesses. Diagnosis by sonography and computed tomography.Radiol Clin North Am 21:425–443, 1983
Haaga JR, Alfidi RJ, Havrilla TR et al.: CT detection and aspiration of abdominal abscesses.Am J Roentgenol 123:465–474, 1977
Wolverson MK, Jagannadharao B, Sundaram M et al.: CT as a primary diagnostic method in evaluating intra-abdominal abscess.AJR 133:1089–1095, 1979
Rubinson HA, Isikoff MB, Hill MC: Diagnostic imaging of hepatic abscesses: a retrospective analysis.AJR 135:735–740, 1980
Terrier F, Becker D, Triller JK: Morphologic aspects of hepatic abscesses at computed tomography and ultrasound.Acta Radiol Diagn 24:129–137, 1983
Silverman PM, Korobkin M, Halvorsen RA, Heaston KD, Akari OE: Computed tomographic detection of spontaneously necrotic tissue.Comput Radiol 9:51–55, 1985
Halvorsen RA, Korobkin M, Foster WL, Silverman PM, Thompson WM: The variable CT appearance of hepatic abscesses.AJR 142:941–946, 1984
Laurin S, Kaude JV: Diagnosis of liver-spleen abscesses in children — with emphasis on ultrasound for the initial and follow-up examinations.Pediatr Radiol 14:198–204, 1984
Burgener FA, Hamlin DJ: Contrast enhancement of hepatic tumors in CT: comparison between bolus and infusion techniques.AJR 140:291–295, 1983
Quint LE, Glazer GM: CT evaluation of the bile ducts in patients with fatty liver.Radiology 153:755–756, 1984
Kuligowska E, Connors SK, Shapiro JH: Liver abscess: sonography in diagnosis and treatment.AJR 138:253–257, 1982
Dewbury KC, Joseph AEA, Sadler M, Birch SJ: Ultrasound in the diagnosis of early liver abscess.B J Radiol 53:1160–1165, 1980
Drum DE: Current status of radiocolloid hepatic scintiphotography for space occupying disease.Semin Nuc Med 12:64–74, 1982
Miedema BW, Dineen P: The diagnosis and treatment of pyogenic liver abscesses.Ann Surg 200:328–335, 1984
Katzenstein D, Rickerson V, Braude A: New concepts of amebic liver abscesses derived from hepatic imaging, serodiagnosis and hepatic enzymes in 67 consecutive cases in San Diego.Medicine 64:237–246, 1982
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Halvorsen, R.A., Foster, W.L., Wilkinson, R.H. et al. Hepatic abscess: Sensitivity of imaging tests and clinical findings. Gastrointest Radiol 13, 135–141 (1988). https://doi.org/10.1007/BF01889042
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DOI: https://doi.org/10.1007/BF01889042