Case Of Liver Abscess Research Articles

Multi-Slice Computer Tomography Dynamic Enhanced Expression and Clinical Significance of Hepatic Perfusion Abnormalities

<p><strong>Objective: </strong>To investigate the imaging features and clinical significance of the dynamic enhanced CT perfusion of the liver. <strong>Method: </strong>112 cases of hepatic perfusion disorders were collected, including 22 cases of hepatocellular carcinoma with tumor thrombus, 12 cases of bile duct carcinoma, 16 cases of cholangitis, 31 cases of hemangioma, 10 cases of liver cirrhosis and liver laceration injury in 5 cases, 16 cases of liver abscess, all cases were surgically or clinically confirmed. All cases were performed with three phase enhanced scanning, and the images were loaded into the PACS system. <strong>Results</strong><strong>: </strong>In 26 cases, 76 cases with patchy enhancement around the focus were shown in 10 cases with patchy enhancement. Arterial phase was in 47 cases, 12 cases with high perfusion, and 53 cases with high perfusion. <strong>Conclusion: </strong>Correct understanding of liver perfusion abnormalities in the diagnosis of lesions and reduce the true extent of the lesion is important.</p>

Achromobacter xylosoxidans: A Rare Infection Masquerading as Metastatic Hepatic Malignancy

Introduction: The incidence of pyogenic liver abscesses is estimated to be 3.6 per 100,000 in the United States. Achromobacter xylosoxidans (AX) is an aerobic, motile, gram-negative bacillus, often misidentified as Pseudomonas aeruginosa, that can be isolated in hospital and domestic sink drains. Bacteremia and bronchiolitis due to AX has been described in patients after liver transplantation for Caroli’s disease and cystic fibrosis, respectively. Although it may be found occasionally in the bile, it is very rarely the cause of liver abscess in immunocompetent patients. Rare cases of liver and intraabdominal abscesses caused by AX have been described in association with prior cholecystectomy. We describe a rare case of AX infection mimicking hepatic malignancy in an immunocompetent patient after cholecystectomy and ERCP. A 66-year-old female with history of open cholecystectomy for gangrenous cholecystitis, ERCP for gallstone pancreatitis, PPD+, and recent colonoscopy with polypectomy, was admitted for right upper quadrant abdominal pain, nausea, and weight loss. Laboratory work-up showed WBC count of 13 with 77% neutrophils, platelets 575, total bilirubin of 1.4 mg/dL, and alkaline phosphatase 255 U/L. CT of the abdomen revealed 2 solid masses in the liver. CEA, CA 19-9, AFP, and CA-125 were normal. CT of chest showed only emphysematous changes. Two needle liver biopsies showed fibroinflammatory tissue with focal necrotizing granulomas, and large droplet steatosis, compatible with an infectious process suggestive of AX. The patient was treated with sulfamethoxazole/trimethoprim 800/160 mg, and within 2 weeks, she demonstrated significant improvement in appetite and weight gain. After 6 weeks of therapy, she was asymptomatic with complete resolution of the lesions on repeat MRI. While AX is a ubiquitous waterborne nosocomial organism, it rarely causes infections in immunocompetent hosts. Hepatic involvement may mimic metastatic malignancy and may pose additional diagnostic challenges. It is important to be cognizant of this rare cause of liver abscess in immunocompromized and immunocompetent patients after cholecystectomy and ERCP.

MRSA Liver Abscess Associated With Very High CA 19-9 Levels

Case Report: An 85-year-old female presented with left-sided chest pain. Past medical history: breast cancer, modified radical mastectomy 20 years ago, a-fib, and hypertension. CTA-chest showed no pulmonary embolism, but incidentally showed cystic lesions in the liver, including 1 large complex cystic mass in the left lobe of the liver. Exam: temperature of 101.8° F, BP:95/53 mmHg. Cardiac: irregularly irregular rhythm. Abdomen: generalized abdominal tenderness. Labs: AST:56 IU/L, WBC:12.8 K/uL, neutrophils:80%. Metastatic disease to the liver was suspected. CEA and alpha fetoprotein were normal, but the CA19-9 was 1387 U/mL (normal: 0-35). Liver ultrasound revealed right lobe simple cyst and a complex left lobe cyst containing thick septations and soft tissue lobularity, as well as internal echoes. MRI revealed no increased enhancement within the previously visualized complex cyst and no other abdominal pathology. Blood cultures were positive for Klebsiella pneumoniae. She underwent percutaneous drainage of the hepatic cyst, and the culture grew MRSA and Klebsiella. The hepatic cyst wall and abscess cytology study was negative for malignancy. She responded well to antibiotics. Serial measurements of serum CA19-9 showed progressive decline with antibiotic treatment. Discussion: High elevations of CA 19-9 can be seen in various benign diseases, but elevations associated with liver abscess are thought to be rare. High CA 19-9 levels are usually associated with biliary and pancreatic malignancies; in the latter, it is considered an accepted tumor marker, and high concentration in serum signifies a poor prognosis. There are very few documented cases of liver abscess associated with high CA 19-9 levels, and our PubMed search did not identify prior reports associating it with MRSA liver abscess (search terms: CA 19-9, liver abscess, MRSA). Most pyogenic liver abscesses are polymicrobial; mixed enteric facultative and anaerobic species are the most common pathogens. Staphylococcus aureus is only found in around 7% and usually results from hematogenous dissemination from a preexisting infection elsewhere in the body. In our patient, CA 19-9 levels decreased after treatment with appropriate antibiotics, which suggests that CA 19-9 might be a useful marker of treatment response in cases of MRSA liver abscesses.Figure 1

Liver abscess secondary to umbilical catheterization in a newborn

We present a case of liver abscess in a 34-week preterm infant after umbilical venous catheterization (UVC). The infant had clinical symptoms of intestinal sepsis, with an encapsulated hypodense hepatic focal lesion with air inside, as observed by abdominal tomography. Staphylococcus aureus was isolated in blood cultures. Liver abscess is a rare complication associated with umbilical catheterization and can be prevented by implementing an appropriate prevention program.

Gas-forming liver abscess in a patient with multi-organ failure: role of imaging and management

We present an unusual case of air-containing liver abscess demonstrated on plain film and ultrasonography with successful treatment utilizing ultrasound-guided drainage in a patient in septic shock. Although surgical drainage is often indicated, ultrasound-guided catheter drainage along with supportive antibiotic therapy can be a safe treatment alternative in critical patients.

English

Liver abscess could be amoebic, pyogenic, infected hydated, traumatic or ascaridal. Amoebic liver abscess follows 1-2months after amoebic dysentery due to invasion of liver by Entamoeba Histolytica via portal circulation. The study was taken by considering the following aims and objectives: Evaluation of clinical symptoms and signs of liver abscess. To evaluate the best modality of management of liver abscess. To evaluate the common microbiological organism responsible for liver abscess. Evaluation of mortality of liver abscess and its survival rate. This study was carried out in the Department of Surgery, G.R. Medical College and J.A. Group of Hospitals, Gwalior between July 2006 to October 2007. Total of 73 cases of liver abscess were included in the study. From our study of liver abscess, it was concluded that if the diagnosis of the liver abscess was made early, the survival of patients was good. The modern day ultrasound and other non-invasive imaging techniques had greatly revolutionized the diagnosis of the liver abscess. Out of the different treatment modalities for the liver abscesses, the main stay of treatment in both amoebic and pyogenic liver abscesses was antibiotics with USG guided percutaneous needle aspiration. If abscess cavity was larger and filling repeatedly, continuous drainage of liver abscess with Pig tail catheter along with antibiotics was required. In very few patients where aspiration could not be possible due to thick pus, septed cavity of abscess, and loculated abscess or there was rupture of abscess in any

Balantidium Coli liver abscess: first case report from India.

Protozoal infections are common in the tropics. Amoebic colitis is the commonest of these infections and can lead to liver abscess as a complication. Balantidium coli is a rare free moving protozoal parasite which is known to infest human large intestine causing a type of colitis very similar to that caused by Entamoeba histolytica. However this pathogen is not known to cause liver invasion in humans. We report here a case of liver abscess caused by B. coli, which is probably the first such case reported in Indian literature.

Biliary Fistula Treated with Endoscopic Therapy in Amoebic Liver Abscess with Cirrhosis

Large amoebic liver abscess is treated with either needle aspiration or percutaneous catheter drainage. Biliary communication of amoebic liver abscess has been reported in up to 27% of cases. Biliary fistula suspected by presence of bile in percutaneous draining catheter and confirmed by endoscopic retrograde cholangiopancreatography. Endoscopic therapy with sphincterotomy and biliary stent placement appears to be an effective mode of treatment for biliary fistulas complicating liver abscesses. Liver abscess is rare in cirrhosis. Here we are reporting a case of amoebic liver abscess with biliary fistula in a chronic liver disease patient which was managed with biliary sphincterotomy and biliary stent placement. A 45 Year old male alcoholic presented with fever of 1 week duration, right hypochondriac pain, abdominal distention and breathlessness. Abdominal examination revealed tenderness over the intercostal region and right hypochondriac area with mild ascites and right-sided pleural effusion. Investigations revealed neutrophilic leukocytosis (43,900cells/mm3) with elevated liver enzymes (SGOT: 102 U/L, SGPT: 169 U/L), alkaline phosphatase (649 U/L), ultrasound abdomen suggestive of coarsened echo texture of liver with surface irregularity and also liver abscess of size about 9.8 × 8.7 cms in segment VII of liver. He was also incidentally detected HBsAg positive. Ascitic fluid analysis suggestive of high SAAG, culture showed no growth of organisms. Blood culture was sterile. Hence diagnosed as cirrhosis with liver abscess. Patient was started on intravenous metronidazole and pipercillin and tazobactum. In view of large abscess and persistent symptoms percutaneous pigtail catheter placed into the liver abscess, anchovy sauce colored pus drained out. After few days of pigtail placement, bile was draining out of the catheter. Suspected biliary fistula, tubogram revealed communication between abscess and biliary radicles. Patient was treated conservatively for 1 month, but still bile was draining out of the catheter. Biliary sphincterotomy done and common bile duct stent was placed. Drain from percutaneous catheter decreased <10 ml per day and percutaneous catheter removed. Patient was doing well and discharged. Follow up did not show any recurrence of abscess.

Capsule deletion via a λ-Red knockout system perturbs biofilm formation and fimbriae expression in Klebsiella pneumoniae MGH 78578

BackgroundKlebsiella pneumoniae is a leading cause of hospital-acquired urinary tract infections and pneumonia worldwide, and is responsible for many cases of pyogenic liver abscess among diabetic patients in Asia. A defining characteristic of this pathogen is the presence of a thick, exterior capsule that has been reported to play a role in biofilm formation and to protect the organism from threats such antibiotics and host immune challenge.FindingsWe constructed two knockout mutants of K. pneumoniae to investigate how perturbations to capsule biosynthesis alter the cellular phenotype. In the first mutant, we deleted the entire gene cluster responsible for biosynthesis of the extracellular polysaccharide capsule. In the second mutant, we deleted the capsule export subsystem within this cluster. We find that both knockout mutants have lower amounts of capsule but produce greater amounts of biofilm. Moreover, one of the two mutants abolishes fimbriae expression as well.ConclusionsThese results are expected to provide insight into the interaction between capsule biosynthesis, biofilm formation, and fimbriae expression in this organism.

重症化した急性虫垂炎が原因と考えられる肝膿瘍の1例

重症化した急性虫垂炎が原因と考えられる肝膿瘍の1例

A case of liver abscess caused by Entamoeba histolytica

A case of liver abscess caused by <i>Entamoeba histolytica</i>

A case of ruptured liver abscess manifesting with intestinal obstruction

Liver abscess manifests with various clinical features. Features include vague abdominal pain, bowel disturbances, jaundice, and rarely abdominal swelling. The sheer plethora of the manifestations can confuse an unwary surgeon. Liver abscess manifesting with intestinal obstruction is rarely reported. This is one such case of liver abscess which manifested with intestinal obstruction which highlights a different mode of presentation of liver abscess.

Presentation and Management of Pyogenic Liver Abscess in Surgery Department: About 34 Cases

AIM: To describe the clinical features, imaging findings, bacteriologic profile, etiology, treatment and outcome in patients presenting pyogenic liver abscess in a Tunisian hospital. METHODES: We report, in a retrospective study, 34 cases of pyogenic liver abscess that were hospitalized between January, 1st 2004 and December, 31st 2013. RESULTS: Thirty-four cases (19 males, 15 females) were found. The mean age was 64 years. The most significant clinical features of pyogenic liver abscess were upper abdominal pain with high grade fever and hepatomegaly. Thirty-one patients were investigated by CT scan, which showed a positive diagnosis in 100% of cases, 82.4% of liver abscesses were found in the right lobe of liver and were solitary in 79.4% of cases. The most causative germs, were isolated in pus culture, were Escherichia coli and Klebsiella. The most common etiologies were biliary and cryptogenic origin; portal pyemia and hematogenous origin were also found. All of patient had received intravenous antibiotic therapy (cephalosporin or fluoroquinolones combination with metronidazole and aminoglycoside) but only two patients were healed by this regime. The mean duration of intravenous antibiotic therapy was 15.5 days. The percutaneous drainage was performed in 50% (n=17) of cases and was successfully in about 70% of cases. Surgery was performed in 58.82% (n=20) of cases. Six patients had only surgical drainage of abscess and the other 14 patients had cholecystectomy with drainage of abscess.The mean length of hospital stay was 19.7 days. The outcome was generally favorable with the exception of one death from septic shock. CONCLUSION: PLA is a rare condition but has undergone a huge change. It affects the subjects increasingly older. Bacteriologically, there is an emergence of Klebsiella in favor of Escherichia coli. Its treatment became less chirurgical thanks to the development of percutaneous drainage. Its outcome is generally favorable.

緊急手術を施行した進行胃癌の肝被膜直接浸潤による肝膿瘍の１例

緊急手術を施行した進行胃癌の肝被膜直接浸潤による肝膿瘍の１例

多発肝膿瘍を伴い転移性腫瘍と鑑別が困難であった十二指腸乳頭部癌の1例

症例は69歳，女性．主訴は心窩部痛と発熱で，肝機能障害と炎症反応がみられ，内視鏡で乳頭部腫瘍による急性胆道炎と診断した．造影CTを行うと肝内に造影早期相で辺縁がリング状増強を示す低吸収性腫瘤が多発性に認められた．これら肝腫瘤は，USでは辺縁低エコー帯を伴う低エコー性腫瘤として，造影MRIは早期相で辺縁がリング状増強を示し，肝細胞相で低信号となり，転移性腫瘍の可能性が高いと考えた．FDG-PETは肝腫瘤に集積がなく，経過観察して肝腫瘤が消失したため，肝膿瘍と判断した．開腹所見も肝転移はなく治癒切除に至り，術後2年を経過し再発徴候はない．乳頭部癌は他の胆道癌よりも肝膿瘍を伴う頻度が高く，転移性腫瘍との鑑別診断において特に注意を要する．FDG-PETは転移と膿瘍の鑑別に有用であった．診断が困難な場合は，慎重な経過観察を行い短期間で再検することが重要と考えた．

A case of multiple liver abscesses associated with Streptococcus salivarius in a patient with chronic periodontitis

A case of multiple liver abscesses associated with <i>Streptococcus salivarius</i> in a patient with chronic periodontitis

English

BACKGROUND/AIM: Liver abscess though a relatively rare condition is a significant health problem in developing countries. Since the presentation, etiology and stage of the abscess varies to a large extent and in view of various possible complications that might arise in this condition defining the treatment strategies for this condition has always been a complex issue. In this study we will try to evaluate efficacy, recurrence rate, complications, morbidity & mortality, duration of hospital stay associated with various management strategies. MATERIALS AND METHODS: The following study was done in a set of 100 patients diagnosed with liver abscess admitted in our hospital. The management strategies compared includes use of antibiotics alone, Sonographic guided percutaneous drainage with Antibiotics and operative intervention in complicated cases. The efficacy, recurrence rate, complications, morbidity & mortality, duration of hospital stay associated with each management strategy was evaluated and observed. Followup was done for a mean period of 12.54 months. RESULTS: Of the 100 cases of liver abscesses included in this study, 26 cases (26.0%) who had abscess less than 200 cc or multiple small abscess involving both lobes were managed conservatively.74/100 (74%) who had abscess > 200 cc or left lobe abscesses were subjected to Intervention. Out of 74 cases patients underwent percutaneous drainage or laparotomy or laparoscopic drainage as required. There were no deaths in the study group. CONCLUSION: Thus in majority of cases percutaneous aspiration was the main form of treatment. All patients were started on antibiotics which were continued for 10- 14 days depending on improvement. Majority of patients responded excellently to percutaneous aspiration and antimicrobials. While patients who had smaller abscesses or multiple small abscesses were successfully managed with antimicrobial therapy alone but relapse rates were high. Mortality was not observed in our series. Recurrence rate was 8.0% and recurrence rate in conservatively managed group was 30.7% while that in operatively managed cases is 0%.

Brucelloma diagnosis and treatment: Report of two cases

Objective: We intend to describe two cases of brucellar liver abscess reviewing their clinical presentation, diagnostic clues, characteristic findings on imaging and special treatment needs. Material and methods: We present clinical and imaging data and review the current medical literature. We report two cases. Case One: 58-year-old man with toxic syndrome and right upper quadrant pain of three weeks of evolution. Case Two: 43-year-old man with fever, weakness and arthralgia of 4 weeks of evolution. Results: Case One: Abnormal laboratory findings were as follows: GGT 80 IU/l, ESR 77 mm, CRP 160 mg/l, and Rose Bengal positive. Wright's agglutination test was found to be positive at 1/160. Abdominal ultrasonography (US) showed a 2 cm per 2.5 cm rounded hypodense area with central calcification that was later confirmed by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Drainage was performed by open surgical drainage. The patient was also treated with streptomycin (1000 mg/day) and doxycycline (200 mg/day). Case Two: Abnormal laboratory findings were as follows: ESR 98 mm, AST 145 IU/L, ALT 33 IU/L, ALP 127 IU/L, CRP 110 mg/dl, and Rose Bengal positive; Wright’s agglutination test was found to be positive at 1/10 ∗ 6. Blood cultures were positive for Brucella. US showed a liver abscess of 3 cm with central calcification and heterogeneous containing. Drainage by laparotomy was performed and treatment with doxycycline (200 mg/day) and streptomycin (1000 mg/day) as well as in the other case. Both had a good early response, they were discharged with a regime of doxycycline 200 mg/day orally for another two months and had no relapse during a 6-month follow-up. Discussion: The diagnosis of brucellar liver abscess is based on the demonstration of specific antibodies at significant titers or seroconversion, like Wright's seroagglutination ≥ 1/160 or a Coombs' antibrucella test ≥ 1/320 and a pseudotumoral heterogeneous lesion with central calcification visible by US, CT and MRI. Surgical drainage and treatment with streptomycin and doxycycline appear to be the most effective option. Conclusions: Brucellar liver abscess is a very rare complication in brucellosis and is easily diagnosed by clinical suspicion supported by positive serology and characteristic image features visible by US, CT and MRI. Brucellosis is a zoonotic infection that can affect almost any organ. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella infection.

The Importance of Monitoring Biliary Stents: A Rare Case of Streptococcal Anginosus Liver Abscesses Due to Stent-Related Biliary Obstruction

The Importance of Monitoring Biliary Stents: A Rare Case of Streptococcal Anginosus Liver Abscesses Due to Stent-Related Biliary Obstruction

PTH-065 Diagnostic and Therapeutic Utility of Spyglass single Operator Peroral Cholangioscopy for Indeterminate Biliary Lesions: A Single Centre Experience in Scotland

IntroductionThe SpyGlass single-operator peroral cholangioscopy is a promising technique designed to overcome some of the limitations of conventional peroral cholangioscopy. We aimed to evaluate the diagnostic utility of the SpyGlass...