1. LIVER ABSCESS
DIAGNOSIS

2. LABORATORY FINDINGS
Elevated serum concentration of Alkaline Phosphatase
Single most reliable laboratory finding
Documented in 70% of patients with liver abscesses
Other tests of liver function may yield normal results
50% of patients have elevated serum levels of bilirubin
48% have elevated concentrations of aspartate aminotransferase
Other laboratory findings
Leukocytosis in 77% of patients
Anemia (usually normochromic, normocytic) in 50%
Hypoalbuminemia in 33%
Concomitant bacteremia is found in one-third of patients

4. New elevation of the right hemidiaphragm is seen
CHEST RADIOGRAPHY
Other suggestive findings include a right basilar infiltrate and a right pleural effusion
New elevation of the right hemidiaphragm is seen

5. IMAGING STUDIES Most reliable methods for diagnosing liver abscesses
Ultrasonography CT
Indium-labeled WBC or gallium scan
MRI

8. CT examination: Unenhanced axial scan: Round-shaped, hypodense masses
of 5-6 cm of diameter, with isodense wall,
are visible in both liver lobes (arrows).
A small amount of hypodense fluid is observed within the liver capsule

9. CT examination: Postcontrast axial scan:
The irregular hypodens lesions of
variable sizes (arrows) are better
visualized in the contrast-enhancing
liver parenchyma.

10. ETIOLOGIC AGENTS In liver infection arising from the biliary tree
Enteric gram-negative aerobic bacilli
Enterococci
Previous surgery has been performed
Anaerobes
Not generally involved in liver abscesses arising from biliary infections
Liver abscesses arising from pelvic and other intraperitoneal sources
Mixed flora including both aerobic and anaerobic species is common
B. fragilis is the species most frequently isolated
Hematogenous spread of infection
Usually only a single organism is encountered
Species may be S. aureus or a streptococcal species such as S. milleri

11. Results of cultures obtained from drain sites are not reliable for defining the etiology of infections.
Liver abscesses may also be caused by Candida spp.
Such abscesses usually follow fungemia in patients receiving chemotherapy for cancer and often present when PMNs return after a period of neutropenia
Amebic liver abscesses are not an uncommon problem
Amebic serologic testing gives positive results in >95% of cases; thus, a negative result helps to exclude this diagnosis