Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Pyogenic Granuloma Pyogenic Liver Abscess 1257

follow-up

■After removal, no follow-up is usually needed.

complications and prognosis

■Recurrences and development of satellite lesions after therapy are

relatively frequent.

PYOGENIC LIVER ABSCESS

AIJAZ AHMED, MD

history & physical

History

■Predisposing conditions: intraabdominal infection (diverticulitis,

peritonitis); Crohn disease; cholangitis, stones, or endoscopic bil-

iary intervention; previous abdominal surgery or liver biopsy; after

trauma; diabetes; malignancy

Signs & Symptoms

■Fever, chills, abdominal pain, nausea/vomiting, weight loss, pleu-

ritic chest pain, cough/dyspnea, diarrhea, jaundice, tender hep-

atomegaly

tests

Laboratory

■ESR, leukocytosis, anemia; other common findings: bilirubin, AST,

ALT, alkaline phosphatase, & PT

■Microbiology: positive blood cultures (50–100%); aspiration increa-

ses yield (in polymicrobial abscesses, all organisms may not be

detected in blood)

■E coli most common causative organism

Imaging

■US: multiple (occasionally single) round/oval hypoechoeic lesions

w/ irregular margins

■CT: detects up to 95% lesions (reduced attenuation/enhance w/ con-

trast)

differential diagnosis

■Amebic abscess, hydatid cyst