History
The most frequent symptoms of hepatic abscess include the following (see the image below):
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Fever (either continuous or spiking)
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Chills
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Right upper quadrant pain
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Anorexia
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Malaise
Table 1: Presenting symptoms and signs in 715 patients diagnosed with liver abscess.
Cough or hiccoughs due to diaphragmatic irritation may be reported. Referred pain to the right shoulder may be present.
Individuals with solitary lesions usually have a more insidious course with weight loss and anemia of chronic disease. With such symptoms, malignancy often is the initial consideration.
Fever of unknown origin (FUO) frequently can be an initial diagnosis in indolent cases. Multiple abscesses usually result in more acute presentations, with symptoms and signs of systemic toxicity.
Afebrile presentations have been documented.
Physical Examination
Fever and tender hepatomegaly are the most common signs. A palpable mass need not be present. Midepigastric tenderness, with or without a palpable mass, is suggestive of left hepatic lobe involvement.
Decreased breath sounds in the right basilar lung zones, with signs of atelectasis and effusion on examination or radiologically, may be present. A pleural or hepatic friction rub can be associated with diaphragmatic irritation or Glisson capsule inflammation.
Jaundice may be present in as many as 25% of cases and usually is associated with biliary tract disease or the presence of multiple abscesses.
Complications
Complications of liver abscess may include the following:
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Sepsis
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Empyema resulting from contiguous spread or intrapleural rupture of abscess
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Rupture of abscess with resulting peritonitis
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Endophthalmitis when an abscess is associated with K pneumoniae bacteremia
Septic pulmonary embolism may occur in patients with a liver abscess caused by K pneumoniae; a study by Wang et al reported an incidence of 6% in a group of these patients. [7]
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Table 1: Presenting symptoms and signs in 715 patients diagnosed with liver abscess.
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Table 2: Microbiologic results from 312 cases of liver abscess compiled from the literature.
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Table 3: Comparison of the radiologic procedures used in the diagnosis of liver abscess.
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Table 4: Underlying etiology of 1086 cases of liver abscess compiled from the literature.
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Computed tomography (CT) scan findings of liver abscess are shown. A large, septated abscess of the right hepatic lobe is revealed. Abscess was successfully treated with percutaneous drainage and antimicrobial therapy.
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Computed tomography (CT) scan findings of liver abscess are shown. A large anterior abscess involving the left hepatic lobe is revealed. Abscess was successfully treated with percutaneous drainage and antimicrobial therapy.
