Pyogenic Hepatic Abscesses Workup
- Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
A complete blood count (CBC) should be obtained. Anemia is observed in 50-80% of patients.[8, 9] Leukocytosis of more than 10,000/μL is observed in 75-96% of patients.[8, 9] Bands of more than 10% are observed in 40% of patients.
The erythrocyte sedimentation rate (ESR) is commonly elevated.
Liver function tests are helpful. An elevated alkaline phosphatase level is observed in 95-100% of patients.[8, 9] An elevated serum aspartate aminotransferase level, an elevated serum alanine aminotransferase level, or both are observed in 48-60% of patients. An elevated bilirubin level is observed in 28-73% of patients.[8, 9] A decreased albumin level (<3 g/dL) and an increased globulin value (>3 g/dL) are frequently observed.
The prothrombin time (PT) is elevated in 71-87% of patients.
Although chest and abdominal radiographs are nonspecific, they are frequently obtained at the initial evaluation. Chest radiography findings are abnormal in approximately half the patients. Nonspecific findings may include an elevated right hemidiaphragm, subdiaphragmatic air-fluid level, pneumonitis, consolidation, and pleural effusion. If gas-forming organisms are present, the abdominal x-ray film might show evidence of intrahepatic air, portal venous gas, air-fluid levels, or air in the biliary tree.
Radionucleotide sulfur colloid scanning has been completely supplanted by computed tomography (CT) and ultrasonography. Findings can help reliably detect masses larger than 2 cm. The sensitivity of the findings ranges from 50-80%; however, they lack specificity.
Real-time ultrasonography findings are 80-100% sensitive.[6, 9, 16, 24, 25, 26] A round or oval hypoechoic mass is consistent with pyogenic abscess.
CT has become the imaging study of choice for detecting liver lesions.[6, 9, 16, 24, 25, 26] Pyogenic liver abscesses are not enhanced on images after intravenous contrast administration. Triphasic CT scanning with arterial and portal venous phases helps to define the proximity of the abscess to the major branches of the portal and hepatic veins. Findings have sensitivity similar to that of ultrasonography, but they lack specificity. (See the image below.)
Mavilia MG, Molina M, Wu GY. The evolving nature of hepatic abscess: a review. J Clin Transl Hepatol. 2016 Jun 28. 4 (2):158-68. [Medline]. [Full Text].
Ochsner A, DeBakey M, Murray S. Pyogenic abscess of the liver. Am J Surg. 1938. 40:292.
Gerzof SG, Johnson WC, Robbins AH, et al. Intrahepatic pyogenic abscesses: treatment by percutaneous drainage. Am J Surg. 1985 Apr. 149(4):487-94. [Medline].
Kandel G, Marcon NE. Pyogenic liver abscess: new concepts of an old disease. Am J Gastroenterol. 1984 Jan. 79(1):65-71. [Medline].
Rintoul R, O'Riordain MG, Laurenson IF, et al. Changing management of pyogenic liver abscess. Br J Surg. 1996 Sep. 83(9):1215-8. [Medline].
Seeto RK, Rockey DC. Pyogenic liver abscess. Changes in etiology, management, and outcome. Medicine (Baltimore). 1996 Mar. 75(2):99-113. [Medline].
Stain SC, Yellin AE, Donovan AJ, et al. Pyogenic liver abscess. Modern treatment. Arch Surg. 1991 Aug. 126(8):991-6. [Medline].
Branum GD, Tyson GS, Branum MA, Meyers WC. Hepatic abscess. Changes in etiology, diagnosis, and management. Ann Surg. 1990 Dec. 212(6):655-62. [Medline]. [Full Text].
Gyorffy EJ, Frey CF, Silva J Jr, McGahan J. Pyogenic liver abscess. Diagnostic and therapeutic strategies. Ann Surg. 1987 Dec. 206(6):699-705. [Medline]. [Full Text].
Tsai FC, Huang YT, Chang LY, Wang JT. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis. 2008 Oct. 14(10):1592-600. [Medline]. [Full Text].
Pastagia M, Arumugam V. Klebsiella pneumoniae liver abscesses in a public hospital in Queens, New York. Travel Med Infect Dis. 2008 Jul. 6(4):228-33. [Medline].
Cheng HC, Chang WL, Chen WY, et al. Long-term outcome of pyogenic liver abscess: factors related with abscess recurrence. J Clin Gastroenterol. 2008 Nov-Dec. 42(10):1110-5. [Medline].
Lai YC, Lin AC, Chiang MK, Dai YH, Hsu CC, Lu MC, et al. Genotoxic Klebsiella pneumoniae in Taiwan. PLoS One. 2014. 9(5):e96292. [Medline]. [Full Text].
Chu KM, Fan ST, Lai EC, et al. Pyogenic liver abscess. An audit of experience over the past decade. Arch Surg. 1996 Feb. 131(2):148-52. [Medline].
Rockey D. Hepatobiliary infections. Curr Opin Gastroenterol. 1999 May. 15(3):229-33. [Medline].
Hashimoto L, Hermann R, Grundfest-Broniatowski S. Pyogenic hepatic abscess: results of current management. Am Surg. 1995 May. 61(5):407-11. [Medline].
Bowers ED, Robison DJ, Doberneck RC. Pyogenic liver abscess. World J Surg. 1990 Jan-Feb. 14(1):128-32. [Medline].
Chou FF, Sheen-Chen SM, Chen YS, et al. Prognostic factors for pyogenic abscess of the liver. J Am Coll Surg. 1994 Dec. 179(6):727-32. [Medline].
Wang W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic liver abscesses. Surg Today. 2004. 34(4):323-5. [Medline].
Lo JZ, Leow JJ, Ng PL, Lee HQ, Mohd Noor NA, Low JK, et al. Predictors of therapy failure in a series of 741 adult pyogenic liver abscesses. J Hepatobiliary Pancreat Sci. 2014 Oct 22. [Medline].
Giorgio A, de Stefano G, Di Sarno A, et al. Percutaneous needle aspiration of multiple pyogenic abscesses of the liver: 13-year single-center experience. AJR Am J Roentgenol. 2006 Dec. 187(6):1585-90. [Medline].
Sung CC, Lin CS, Lin SH, Lin CL, Jhang KM, Kao CH. Pyogenic Liver Abscess is Associated With Increased Risk of Acute Kidney Injury: A Nationwide Population-Based Cohort Study. Medicine (Baltimore). 2016 Jan. 95 (3):e2489. [Medline].
Lai SW, Liao KF, Lin CL, Chen PC. Pyogenic liver abscess correlates with increased risk of acute pancreatitis: a population-based cohort study. J Epidemiol. 2015. 25 (3):246-53. [Medline]. [Full Text].
Benedetti NJ, Desser TS, Jeffrey RB. Imaging of hepatic infections. Ultrasound Q. 2008 Dec. 24(4):267-78. [Medline].
Rubinson HA, Isikoff MB, Hill MC. Diagnostic imaging of hepatic abscesses: a retrospective analysis. AJR Am J Roentgenol. 1980 Oct. 135(4):735-45. [Medline].
Ferrucci JT Jr, vanSonnenberg E. Intra-abdominal abscess. Radiological diagnosis and treatment. JAMA. 1981 Dec 11. 246(23):2728-33. [Medline].
Hope WW, Vrochides DV, Newcomb WL, et al. Optimal treatment of hepatic abscess. Am Surg. 2008 Feb. 74(2):178-82. [Medline].
Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver abscesses - percutaneous or open drainage?. Singapore Med J. 2007 Dec. 48(12):1158-65; quiz 1165. [Medline].
Men S, Akhan O, Koroglu M. Percutaneous drainage of abdominal abcess. Eur J Radiol. 2002 Sep. 43(3):204-18. [Medline].
Onder A, Kapan M, Böyük A, Gümüs M, Tekbas G, Girgin S, et al. Surgical management of pyogenic liver abscess. Eur Rev Med Pharmacol Sci. 2011 Oct. 15(10):1182-6. [Medline].
Yanaga K, Kitano S, Hashizume M, et al. Laparoscopic drainage of pyogenic liver abscess. Br J Surg. 1994 Jul. 81(7):1022. [Medline].
Siu WT, Chan WC, Hou SM, et al. Laparoscopic management of ruptured pyogenic liver abscess. Surg Laparosc Endosc. 1997 Oct. 7(5):426-8. [Medline].
Robles PJ, Lara JG, Lancaster B. Drainage of hepatic amebic abscess successfully treated by laparoscopy. J Laparoendosc Surg. 1994 Dec. 4(6):451-4. [Medline].
Cioffi L, Belli A, Limongelli P, et al. Laparoscopic drainage as first line treatment for complex pyogenic liver abscesses. Hepatogastroenterology. 2014 May. 61 (131):771-5. [Medline].
|Abdominal pain||89-100||Normal findings||38|
|Pleuritic chest pain||9-24||–||–|