ORIGINAL ARTICLES

Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department

A C-M Lin^1,7, D Y Yeh^2,6,6, Y-H Hsu³, C-C Wu⁴, H Chang¹, T-N Jang^5,6,6, C-H Huang^5,6,6

¹ Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
² Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
³ Department of Gastrology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
⁴ Department of Medical Imaging, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
⁵ Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
⁶ School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
⁷ Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan

Correspondence to:
Dr C-H Huang, Division of Infectious Diseases, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan; m002001{at}ms.skh.org.tw

Background: Delayed diagnosis of pyogenic liver abscess remains a challenging problem in the emergency department because of the associated high morbidity and mortality.

Objective: To evaluate the sensitivity of ultrasono-graphy in the diagnosis of pyogenic liver abscess in patients presenting to the emergency department and the factors that may influence this sensitivity.

Methods: A retrospective study was conducted in patients diagnosed with pyogenic liver abscess in the emergency department (ED) of a tertiary care teaching hospital for a period of 5 years. Between May 2001 and April 2006, 268 patients diagnosed with pyogenic liver abscess were evaluated by ultrasonography and/or CT scanning. The age, sex, clinical presentation, location and number of abscesses and the underlying disease of these two groups were compared.

Results: Of the 268 patients admitted via the ED who were discharged or died with a diagnosis of pyogenic liver abscess, there was a predominance of men (M/F 173/95) and the mean age was 57.6 years (range 17–90). 38 had false negative findings on ultrasonography (sensitivity 85.8%) and required abdominal CT scanning for definitive diagnosis. In the other 230 cases, ultrasonography alone was sufficient for diagnosis. Location of the abscess in segments 4 and 5 of the liver raised the sensitivity of ultrasound for diagnosis, while location in segment 8 was most associated with delayed diagnosis by ultrasonography. Right costal angle knocking pain was significant for pyogenic liver abscess even if ultrasound was negative.

Conclusions: The size and location of the liver abscess and the underlying comorbid diseases may affect the diagnostic sensitivity of ultrasound for pyogenic liver abscess in clinical practice. A high index of suspicion should be maintained in patients with diabetes mellitus, previous biliary tract intervention or gastrointestinal malignancy. Follow-up CT scanning is recommended if right flank knocking pain is present, even if ultrasonography is non-revealing. A diagnostic protocol for liver abscess may be feasible in the future.

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