A pus within the liver. The infection is caused by bacteria and is usually polymicrobial, with E. coli and K. pneumoniae being the common causative organisms. The majority of cases are caused by ascending infection from a biliary tract pathology (e.g., cholangitis due to choledocholithiasis, i.e. biliary strictures). Due to the liver's dual blood supply from the portal vein and the hepatic artery, an infectious focus in the gastrointestinal tract or bacteremia exposes the liver to high bacterial loads. Patients, typically middle-aged/elderly males, present with non-specific symptoms, such as fever, malaise, and weight loss. Right upper quadrant pain and tender hepatomegaly are specific features of a liver abscess but are often absent. Diagnosis is confirmed on abdominal imaging (ultrasound or CT), which demonstrates intrahepatic fluid-filled lesions with surrounding edema. Broad-spectrum IV antibiotics (ampicillin + sulbactam) and percutaneous/surgical drainage of the abscess cavity is the mainstay of treatment. Complications include sepsis, pneumonia, and abscess rupture into the peritoneum/thorax. Advancements in diagnostics and treatment have reduced the complications and mortality rates of .is a rare disease characterized by solitary/multiple collections of
- Incidence: 2–3 cases per 100,000 people in the United States
- Peak incidence: 50–60 years
- Sex: slight male predominance
Epidemiological data refers to the US, unless otherwise specified.
- Diabetes mellitus
- Hepatobiliary disease (e.g., cholelithiasis, transplant recipients, hepatic tumors)
- Gastrointestinal malignancy (esp. colorectal carcinoma)
- Crohn's disease
Etiology by source
Biliary tract (∼ 60%): Most common cause
Portal vein (∼ 20%)
Hepatic artery (∼ 15%)
Contiguous area (< 5%)
- (80% of liver abscesses)
- Non-pyogenic liver abscess
- Classic triad of
- Other symptoms
- Physical examination
The symptoms of non-specific (e.g., fever, weight loss, etc.). are often
- Complete blood count: neutrophilic leukocytosis, normocytic normochromic anemia
- Liver function tests: : ↑ alkaline phosphatase (90%), ↑ AST and ALT; , hypoalbuminemia, hyperbilirubinemia
- Inflammatory markers: ↑ ESR and CRP
- Blood culture: positive in ∼ 50% of cases
- Abdominal imaging is a confirmatory test for
- Abdominal ultrasound (US): seen as solitary/multiple, poorly demarcated, fluid-filled, round hypoechoic lesion(s) within the hepatic parenchyma with surrounding edema and hyperemia .
- Abdominal CT scan: Findings are similar to those on abdominal ultrasound; a peripheral rim enhancement is seen on IV contrast administration.
Percutaneous aspiration and culture of the aspirate
- Both diagnostic and therapeutic (see “Treatment” section below)
- Performed under US or CT guidance
- Aspirated material is cultured to determine the organism and its antibiotic-susceptibility profile.
space-occupying lesions of the liver.need to be differentiated from other
The differential diagnoses listed here are not exhaustive.
- Indicated in all cases
- Broad-spectrum IV antibiotics: ampicillin + sulbactam; piperacillin + tazobactam; 3rd generation cephalosporin + metronidazole (until antibiotic susceptibility is available)
Drainage of the abscess cavity
- Indicated in nearly all cases of
- Indication for percutaneous drainage/needle aspiration: solitary abscess
- Indications for surgical drainage (open/laparoscopic)
- Contraindications: coagulopathy (e.g., (INR) > 1.5; thrombocytopenia due to sepsis)
- Pleural effusion
We list the most important complications. The selection is not exhaustive.
- Untreated : 100%
- With treatment: ∼12 %
- Poor prognostic factors