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PubMed1991

Cystic disease of the liver and biliary tract.

The widespread availability of ultrasound imaging has led to more frequent recognition of cystic disease affecting the liver and biliary tract. There is a wide range of possible causes. Cystic disease of infective origin is usually caused by an Echinococcal species, or as the sequel of a treated amoebic or pyogenic abscess. The clinical and radiological features are often then distinctive and will not be dwelt upon in this review, except in respect of their contribution to the differential diagnosis of non-infective disorders. The principal non-infective cysts can be conveniently divided between the simple cyst, the polycystic syndromes (usually with coexistent renal disease), Caroli's syndrome, and choledochal cysts. The overlap between constituent members of these groups, and the association of cystic disease with hepatic fibrosis (especially with congenital hepatic fibrosis) has attracted considerable attention, and it has been suggested that they may all be considered to belong to a hepatobiliary fibrocystic continuum. In addition there are a variety of cystic neoplasms and a miscellany of unusual forms.

Biliary Tract Diseases↗
PubMed1990

Role of computed tomography in the management of recurrent pyogenic cholangitis.

A retrospective analysis was performed to define the indications and usefulness of computed tomography (CT) in the management of 62 patients with recurrent pyogenic cholangitis. When performed in 18 patients in the acute phase for persistent fever inexplicable by ultrasonography and cholangiography, CT scans identified the cause of sepsis to be liver abscesses (n = 7), impacted stones in left lateral segments (n = 3) and right posterior inferior duct (n = 1). When performed in 44 patients during remission, CT scans detected impacted intrahepatic stones as the cause of non-opacification of segmental bile ducts on cholangiograms (n = 15), demonstrated liver volume changes (segmental atrophy, n = 31; hypertrophy, n = 5), differentiated intrahepatic stones from pneumobilia (n = 5) and revealed stones in segregated intrahepatic bile ducts (n = 4). Overall 75.8% of CT scans showed valuable intrahepatic findings which were useful in guiding the appropriate treatment for the intrahepatic pathology. In the others without demonstrable intrahepatic pathology on CT, patients were adequately treated for common bile duct pathology alone. It is recommended that CT should be performed when ultrasonography and cholangiography cannot elucidate the cause of persistent fever, when the cholangiogram shows non-opacification of segmental bile ducts, or fails to demonstrate the cause of recurrent acute cholangitis, particularly in patients who have had previous bilio-enteric drainage procedures.

Adult↗
PubMed1986

Percutaneous drainage of hepatic abscesses in children.

Ultrasound guided percutaneous drainage of seven hepatic abscesses in five pediatric patients was performed. Abscesses were pyogenic in four of the patients and amebic in one. All patients recovered completely without surgical intervention. Methodology necessary in the pediatric patient is stressed.

Adolescent↗
PubMedDate not supplied

Skeletal infections in cirrhotics.

There are few reports of skeletal infections in patients with cirrhosis. We present two such cases, both with alcoholic liver disease, seen over a period of one year. The first, a 46-year-old man, presented as pyrexia of unknown origin, and was found to have pyogenic discitis; he responded to antibiotic and surgery. The second, a 42-year-old man, presented with chest wall abscess and was diagnosed to have tubercular osteomyelitis; he expired despite treatment with non-hepatotoxic anti-tubercular drugs.

Adult↗
PubMed2002

Amebic liver abscess--rare need for percutaneous treatment modalities.

BACKGROUND: Given the often unspecific symptoms of amebic liver abscess, an analysis was done to recognize the most common patterns of presentation. Since treatment recommendations are still inconsistent comparing conservative and interventional treatment modalities, we evaluated treatment modalities in our patients. METHODS: A retrospective case series of all patients with confirmed amebic liver abscess was conducted. Age, sex, country of origin or travel, symptoms, and physical and laboratory findings were recorded. Particular attention was given to the need for interventional measures. RESULTS: 62 patients were reviewed, and nearly all of them (95%) had a travel history. The most common findings were fever (97%), abdominal pain (95%), and hepatomegaly (79%). 11% still had no amebic antibodies on presentation but an increase in the follow-up examinations. In 5% needle aspiration was performed to allow differentiation between amebic and pyogenic etiology. Metronidazole alone quickly cleared symptoms in 92% of the patients. In 8% only, there was a therapeutic need for interventional procedures (3% already ruptured, 5% large abscess formation with the danger of rupture). CONCLUSIONS: In travelers with fever, abdominal pain, and hepatomegaly amebic liver abscess must be considered. Medical treatment with metronidazole is effective in more than 90%. Only in very few cases there is a need for invasive therapeutic modalities.

Abdominal Pain↗
PubMed1993

Hepatic abscess presenting as severe fatigue and anemia.

We describe a 54-year-old woman who had severe anemia as the initial presentation of a pyogenic hepatic abscess. She was afebrile and denied any gastrointestinal symptoms other than anorexia. We discovered her hepatic abscess when we evaluated her for an occult malignancy as the cause of her anemia. She was treated with percutaneous drainage of her abscess and parenteral antibiotic therapy. We searched MEDLINE, a computerized database, to find other patients whose hepatic abscesses presented as anemia. Although mild anemia is a common accompaniment of pyogenic hepatic abscesses, we found no reports of patients who presented with fatigue and anemia without any of the more common symptoms of hepatic abscess, such as fever, right upper quadrant pain, malaise, or nausea. We conclude that anemia without fever or abdominal symptoms is a rare presentation of pyogenic hepatic abscess.

Anemia↗
PubMed1993

Pyogenic hepatic abscess.

Pyogenic hepatic abscess is a rare condition associated with severe sequelae. The diagnosis may be obvious in patients with fever and leukocytosis who are clearly predisposed to this infectious complication. In patients without known risk factors, diagnosis and treatment are often delayed, usually until numerous health care resources have been consulted. The evaluation of occult hepatic abscess may be improved by a history directed at identifying predisposing conditions, by an appropriate physical examination and by the use of computed tomographic scanning. The standard treatment for pyogenic hepatic abscess is percutaneous or open drainage, accompanied by broad-spectrum antibiotic therapy.

Anti-Bacterial Agents↗
PubMedDate not supplied

Hepatic abscesses in elderly patients mimicking metastatic disease.

BACKGROUND: There is considerable overlap between the clinical presentation and radiological appearances of hepatic abscesses and hepatic metastases. The distinction is important given the treatable nature of hepatic abscesses compared with most forms of metastatic disease and the very high morbidity and mortality associated with untreated or missed pyogenic abscesses. AIMS: The aim of this series of case reports is to illustrate this point by presenting the case histories of three elderly patients whose clinical and radiological findings suggested metastatic liver disease, but who were subsequently proven to have liver abscesses. METHODS: A comprehensive review of the clinical and radiological records of three patients. RESULTS: Ultrasound and computer tomography (CT) imaging in all three cases was suggestive of metastatic liver disease. The liver lesions were subsequently proven to be abscesses either by autopsy, needle aspiration or inspection at open surgery. CONCLUSIONS: Liver abscesses can mimic metastatic deposits. Correlation with the white cell count (WCC) can be very helpful. Fine needle aspiration (FNA) of liver lesions should be undertaken, especially if the WCC is elevated.

Aged↗
PubMedDate not supplied

Aspiration cytology of liver abscesses. With an emphasis on diagnostic pitfalls.

Clinical and imaging features of liver abscesses are not specific. Necrotic hepatic neoplasms, primary or secondary, can mimic abscesses, and vice versa. Thirty-eight patients who had cytologic confirmed abscesses were analyzed. There was clinical, radiologic and cytologic concurrence in 27 patients. In six cases the clinically suspicious lesion turned out to be inflammatory. The remaining five were malignant. There were four amebic and three tuberculous cases in this series. Cytologically, pyogenic abscesses contained a heavy, neutrophilic, inflammatory exudate with nuclear debris. By comparison, amebic cases contained more necrotic debris, with degenerating hepatocytes and fewer inflammatory cells. Acid-fast bacilli were identified in two tuberculous abscesses; however, only one contained caseous necrotic material and epithelioid cells. A potential pitfall in the cytologic diagnosis of a case of inflammatory pseudotumor is emphasized. The diagnosis of liver abscess should be established by clinical and imaging findings in conjunction with needle aspiration.

Adult↗
PubMedDate not supplied

[Laparoscopic drainage of liver abscess. Initial experience].

BACKGROUND: Radiologically guided percutaneous drainage has proven to be simple and effective and currently is considered the gold standard of care with success rates between 80 and 87%. However, not all abscesses are amenable to or will resolve with percutaneous drainage. The purpose of this study is to report our 1-year initial experience with laparoscopic drainage of liver abscesses. METHODS: Patients with diagnosis of liver abscess and who had a surgical indication and were submitted to laparoscopic drainage were studied prospectively from January to December of 2004. RESULTS: Six patients underwent laparoscopic drainage. There were three men and three women with a mean age of 50.8 years. Four patients had single lesions and two had multiple lesions. Mean size of the abscesses was 10.9 x 7.7 cm, segments primarily affected were 5 and 8. Two patients had amebic and four pyogenic abscesses. Mean operative time was 142 min. All patients were eating by the day following surgery and were ambulating between 24 and 72 h postoperatively. All patients reported to be asymptomatic at the time of their last visit. There was one recurrence that resolved with a second procedure. CONCLUSIONS: Success rate with the laparoscopic drainage of liver abscesses (83.3%) makes this procedure an effective and viable surgical alternative as a primary approach in selected patients or after a failed percutaneous drainage.

Drainage↗
PubMed1999

Sonographic detection of multiple Staphylococcus aureus hepatic microabscesses mimicking Candida abscesses.

We report the sonographic, CT, and clinical findings in a patient presenting with clinical sepsis and multiple Staphylococcus aureus hepatic microabscesses. Although contrast-enhanced CT has had a higher sensitivity than sonography in detecting hepatic microabscesses in some studies, this examination was negative in our patient. On sonography, numerous small hypoechoic lesions were present. Some target-like lesions had a striking similarity to Candida albicans microabscesses. The hepatic lesions were believed to be pyogenic liver microabscesses, as several blood cultures were positive for S. aureus. Following prolonged intravenous antibiotic therapy, all the hypoechoic hepatic lesions disappeared, along with the clinical and biochemical signs of sepsis.

Adult↗
PubMed1985

Pyogenic hepatic abscess and diabetes mellitus--a probable association.

Four patients with pyogenic hepatic abscesses are reported. There were three females and one male with an age range of 36-75 years. In all the cases, diabetes mellitus was associated. Confirmation of the abscesses was obtained by liver scanning or ultrasonography, or both. In one patient, the clinical course was complicated by sympathetic pericardial effusion with right heart failure. Two patients had percutaneous transhepatic drainage of the abscesses under fluoroscopy. All four patients eventually required laparotomy and open drainage of the abscesses. Diabetic control was achieved with insulin therapy. The common causative organism in all instances was the Klebsiella species. Three patients recovered. The remaining one developed hypotension post-operatively and died of brain-stem infarction and the hepato-renal syndrome.

Adult↗