Article Text

PDF
Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department
  1. A C-M Lin1,7,
  2. D Y Yeh2,6,6,
  3. Y-H Hsu3,
  4. C-C Wu4,
  5. H Chang1,
  6. T-N Jang5,6,6,
  7. C-H Huang5,6,6
  1. 1
    Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  2. 2
    Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  3. 3
    Department of Gastrology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  4. 4
    Department of Medical Imaging, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  5. 5
    Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  6. 6
    School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
  7. 7
    Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
  1. Dr C-H Huang, Division of Infectious Diseases, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan; m002001{at}ms.skh.org.tw

Abstract

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.

Statistics from Altmetric.com

Footnotes

  • Competing interests: None.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.