Liver mass…differential diagnosis


This patient presented with right upper quadrant pain.  I asked last week what your differential diagnosis would be:

Liver Mass 1

Liver mass 2

The CT above shows a multiloculated, rim-enhancing mass in the liver parenchyma.  This is consistent with an abscess.  The differential diagnosis starts by breaking down the categories into bacterial, fungal, and amebic causes. 

Bacterial:  Abscesses can form from ascending cholangitis, especially in setting of biliary malignancies.   Klebsiella pneumoniae has been reported to cause hepatic abscesses, especially in E. Asia (1).  Patients with recent instrumentation (hepatocellular carcinoma embolization, etc) are at risk for MRSA, streptococcus species.  Tuberculosis has been known to cause hepatic abscesses as well.

Fungal:  Disseminated candidiasis in the immunocompromised host can lead to liver and splenic abscesses

Amebic:   Liver abscess is the most common manifestation of extraintestinal entamoeba histolytica (2).  In endemic areas or travelers to endemic areas are at risk for this occurrance. 

Author:  Russell Jones, MD

References

1.  Davis J, McDonald M.  Pyogenic Liver Abscesses.  www.uptodate.com

2.  Leder K, Weller P.  Extraintestinal Entamoeba Histolytica Amebiasis.  www.uptodate.com

 

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EMREMS: Radiology in Emergency Medicine

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