Pyogenic liver abscess differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Pyogenic liver abscess must be differentiated from other diseases with similar presentation such as amoebic liver abscess, fungal liver abscess, echinococcal (hydatid) cyst and malignancy (hepatocelluar carcinoma or metastasis).

Differential Diagnosis

Pyogenic liver abscess must be differentiated from:

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 ✔		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	Bacteria Gram-positive aerobes Gram-negative enterics Anaerobic organisms Acid fast bacilli	✔	✔	✔✔	✔✔	✔/✘	✔✔✔	✔ (acute loss)	✔		✔	Pale/dark	Hypoalbuminemia ✔✔✔		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	Candida species	✔	✔		✔	✔	✔	✔	✔	✔	✔				Less common Pure fungal abscess or associated with pyogenic abscess
Echinococcal (hydatid) cyst	Echinococcus granulosus		✔		✔		✔	✔	✔						Blood or liquid from the ruptured cyst may be coughed up
Malignancy (Hepatocellular carcinoma/Metastasis)	Hepatitis B and C Aflatoxins Alcohol Heamochromatosis Alpha 1 antitrypsin deficiency Non alcoholic fatty liver disease		✔ (uncommon)			✔	✔								Other symptoms: Splenomegaly Variceal bleeding Ascites Spider nevi Asterixis