Case #10
   
LIVER ABSCESS
   
 
Liver abscesses can be bacterial, parasitic, or fungal in origin. Approximately 85% to 90% are bacterial or pyogenic. Bacteria access the liver via the biliary tree or portal vein. Causes include biliary obstruction, diverticulitis, trauma, inflammatory bowel disease, and iatrogenic causes. Patients present with pain, fever, diarrhea, leukocytosis, and abnormal liver function tests (LFTs). The most common location of a pyogenic abscess is the right lobe.
 
CT demonstrates a heterogeneous lesion with irregular margins and possibly peripheral contrast enhancement. Internal septations are common. The radiologic differential diagnosis includes cystic or necrotic metastases (ovarian or leiomyosarcoma), and hydatid and echinococcal cysts. Often the diagnosis of a bacterial abscess is suggested clinically.
 
Treatment consists of percutaneous or surgical drainage and antibiotics. The mortality rate is almost 100% if the abscess remains untreated.