Amoebic liver abscess differential diagnosis: Difference between revisions
Line 24: | Line 24: | ||
! rowspan="2" | Anorexia | ! rowspan="2" | Anorexia | ||
! rowspan="2" | Diarrhoea | ! rowspan="2" | Diarrhoea | ||
or | or Dysentry | ||
Dysentry | |||
! rowspan="2" | Nausea and | ! rowspan="2" | Nausea and | ||
vomiting | vomiting | ||
Line 39: | Line 38: | ||
histolytica | histolytica | ||
|✔✔✔ | |✔✔✔ | ||
|✔✔✔ | |||
|✔/✘ | |||
|✔ | |✔ | ||
| | |✔✔/✘ | ||
|✔ | |✔ | ||
(late stages) | (late stages) | ||
Line 51: | Line 50: | ||
|✔ | |✔ | ||
| | | | ||
|Hypoalbuminemia | |||
(✔) | |||
| | | | ||
* Ultrasound is the gold standard technique for diagnosing amoebic liver abscess | |||
| | | | ||
* Respond well to chemotherapy and rarely require drainage | |||
* | * Marked male predominance | ||
* More common in developing countries | |||
* Sero-positive | |||
* Right lobe is more frequently involved | |||
|- | |- | ||
|Pyogenic liver abscess | |Pyogenic liver abscess | ||
Line 64: | Line 70: | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
| | |✔✔ | ||
| | |✔✔ | ||
|✔ | |✔/✘ | ||
| | |✔✔✔ | ||
|✔ | |✔ | ||
(acute loss) | (acute loss) | ||
|✔ | |✔ | ||
| | | | ||
|✔ | |✔ | ||
|Pale/dark | |Pale/dark | ||
|Hypoalbuminemia | |||
(✔✔✔) | |||
|Cluster sign | |||
* CT scan shows cluster sign | |||
* Aggregation of multiple low attenuation liver lesions in a localized area to form a solitary larger [[abscess]] cavity | |||
| | | | ||
* Abnormal pulmonary findings | |||
* Diabetes mellitus increases the risk | |||
* Medical-surgical approach is indicated | |||
* More common in developed countries | |||
* Culture positive and sero-negative | |||
* Both lobes are commonly involved | |||
|- | |- | ||
|Fungal liver abscess | |Fungal liver abscess | ||
Line 82: | Line 98: | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
| | |✔/✘ | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
Line 92: | Line 108: | ||
| | | | ||
| | | | ||
|CT and Us findings with four patterns of presentation: | |||
* Wheel-within-a-wheel pattern | |||
* Bull’s-eye configuration pattern | |||
* Uniformly hypoechoic nodule | |||
* echogenic foci with variable degrees of posterior acoustic shadowing | |||
| | | | ||
* Less common | |||
* Pure fungal abscess or associated with pyogenic abscess | |||
* Candida and Aspergillus are commonly found in the culture of aspirated pus | |||
* Associated with underlying malignancy or DM | |||
|- | |- | ||
|Echinococcal (hydatid) cyst | |Echinococcal (hydatid) cyst | ||
Line 104: | Line 128: | ||
| | | | ||
|✔ | |✔ | ||
(Obstructive jaundice) | |||
|✔ | |✔ | ||
|✔ | |✔ | ||
Line 109: | Line 134: | ||
| | | | ||
| | | | ||
| | |Histology: Hydatid cyst with three layers | ||
| | |||
a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue | |||
b.The endocyst, an inner germinal layer | |||
c.The ectocyst, a thin, translucent interleaved membrane | |||
|Ultrasound: | |||
* Cystic to solid-appearing pseudotumors | |||
* Water lily sign | |||
* Calcifications seen peripherally | |||
| | | | ||
* Blood or liquid from the ruptured cyst may be coughed up | * Blood or liquid from the ruptured cyst may be coughed up | ||
* Pruritis | |||
|- | |- | ||
|Malignancy | |Malignancy | ||
Line 123: | Line 158: | ||
*Alpha 1 antitrypsin deficiency | *Alpha 1 antitrypsin deficiency | ||
*Non alcoholic fatty liver disease | *Non alcoholic fatty liver disease | ||
| | |✔ | ||
|✔ | |✔ | ||
Line 131: | Line 166: | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
|✔✔ | |||
| | | | ||
| | | | ||
|✔✔ | |||
|Pale/Chalky | |||
| | | | ||
* High levels of AFP in serum | |||
* Abnormal liver function tests | |||
| | | | ||
* Liver biopsy | |||
|Other symptoms: | |Other symptoms: | ||
* Splenomegaly | * Splenomegaly |
Revision as of 16:44, 6 March 2017
Amoebic liver abscess Microchapters |
Diagnosis |
Treatment |
Case Studies |
Amoebic liver abscess differential diagnosis On the Web |
American Roentgen Ray Society Images of Amoebic liver abscess differential diagnosis |
Risk calculators and risk factors for Amoebic liver abscess differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
Amoebic liver abscess must be differentiated from other diseases that cause fever, abdominal pain, cough, jaundice, hepatomegaly, anorexia, nausea, vomiting, and pale or dark stools such as pyogenic liver abscess, fungal liver abscess, necrotic hepatoma, echinococcal cyst and hepatocellular carcinoma.
Differential Diagnosis
Amoebic liver abscess must be differentiated from:[1]
Disease | Causes | symptoms | Lab Findings | Imaging Findings | Other Findings | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Pain | cough | Hepatomegaly | Jaundice | Weight loss | Anorexia | Diarrhoea
or Dysentry |
Nausea and
vomiting |
Stool | ||||||
Abdominal pain
(right upper quadrant pain) |
Pleuritic pain | ||||||||||||||
Amoebic
liver abscess |
Entamoeba
histolytica |
✔✔✔ | ✔✔✔ | ✔/✘ | ✔ | ✔✔/✘ | ✔
(late stages) |
✔
(late stages) |
✔ | ✔ | ✔ | Hypoalbuminemia
(✔) |
|
| |
Pyogenic liver abscess | Bacteria
|
✔ | ✔ | ✔✔ | ✔✔ | ✔/✘ | ✔✔✔ | ✔
(acute loss) |
✔ | ✔ | Pale/dark | Hypoalbuminemia
(✔✔✔) |
Cluster sign
|
| |
Fungal liver abscess | Candida species | ✔ | ✔ | ✔/✘ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | CT and Us findings with four patterns of presentation:
|
| ||
Echinococcal (hydatid) cyst | Echinococcus granulosus | ✔ | ✔ | ✔
(Obstructive jaundice) |
✔ | ✔ | Histology: Hydatid cyst with three layers
a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue b.The endocyst, an inner germinal layer c.The ectocyst, a thin, translucent interleaved membrane |
Ultrasound:
|
| ||||||
Malignancy
(Hepatocellular carcinoma/Metastasis) |
|
✔ | ✔
(uncommon) |
✔ | ✔ | ✔✔ | ✔✔ | Pale/Chalky |
|
|
Other symptoms:
|
References
- ↑ Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA (1997). "Fungal hepatic abscesses: Characterization and management". J Gastrointest Surg. 1 (1): 78–84. PMID 9834333.