Diagnosis | Liver abscess

Diagnosis

In addition to questioning the patient about stays in the tropics (parasites) or the presence of gallstones, the physical examination can confirm the suspicion of a liver abscess. For example, the otherwise non-palpable liver is palpable during the physical examination (hepatomegaly) and is painful due to palpitations and pressure. An ultrasound usually shows a liver abscess quite reliably (so-called inhomogeneous foci).

Furthermore, a fine needle puncture can be performed for tissue harvest and examination. An x-ray of the abdomen may sometimes show an elevation of the diaphragm, indicating an enlargement of the liver due to one or more liver abscesses. Fine needle puncture can also be performed under CT control.

Ultrasound is the standard examination in suspected liver abscesses. However, ultrasound is not always sufficient for a reliable diagnosis, so a CT scan must be requested. The ultrasound reveals the liver abscess darker than the rest of the tissue.

Ultrasound can also reveal changes caused by possible parasites. Usually, ultrasound is the standard examination for diagnosis. However, if the ultrasound findings are not conclusive, a CT scan is requested.

The CT is performed with the administration of contrast medium, since the liver abscess has a characteristic marginal contrast medium image. Another feature is that the abscess is distinguished from the rest of the liver tissue by its darker appearance in the CT image. Thus, a reliable diagnosis can be made with the CT.

In some parasites, CT still shows parasite-specific characteristics, such as cysts in the dog tapeworm. Liver puncture for tissue sampling and examination is not relevant in the diagnosis of liver abscesses. However, it is important in the identification of the pathogen.

In the case of a liver abscess due to parasites or amoebas, it is unnecessary. If bacteria are the cause of the liver abscess, puncture is useful. This way, the bacterium can be identified and a specifically effective antibiotic can be taken. However, a puncture is also associated with a few risks.