Imaging

Liver Abscess

Preliminary Diagnosis: Liver Abscess

I. What imaging technique is first-line for this diagnosis

  • Plain radiograph of the chest and abdomen

II. Describe the advantages and disadvantages of this technique for diagnosis of a liver abscess.

Advantages

  • Highly portable

  • Relatively inexpensive imaging modality

Disadvantages

  • Less sensitive and specific in detecting and diagnosing a liver abscess or any liver pathology

  • Does not allow for exquisite visualization of the surrounding anatomic structures

  • Less adept in detailing the primary pathologic process and any secondary complications

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • CT of the abdomen and pelvis with IV contrast

  • MR evaluation of the abdomen and pelvis

  • Ultrasound

  • Nuclear medicine tagged WBC scans

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of a liver abscess.

CT of the abdomen and pelvis with IV contrast

Advantages

  • Highly sensitive and specific in detecting, diagnosing, and characterizing a primary liver abscess and its extent

  • Highly adept in characterizing any secondary complication from a primary liver abscess

  • Helps guide treatment

Disadvantages

  • Exposes patients to ionizing radiation

MR evaluation of the abdomen and pelvis

Advantages

  • Does not expose patients to ionizing radiation

  • Highly sensitive and specific in detecting a primary hepatic abscess and characterizing any secondary complications

  • Offers exquisite imaging of the adjacent biliary system for any secondary complications

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

Ultrasound

Advantages

  • Highly portable

  • Relatively inexpensive imaging modality for evaluating liver pathology

  • Highly sensitive and specific imaging modality for diagnosing and characterizing a liver abscess

  • Helps guide treatment

  • Better evaluates the vascularity of a lesion than other imaging modalities

  • Does not expose patients to ionizing radiation

Disadvantages

  • Operator dependent

Nuclear medicine tagged WBC scans

Advantages

  • Highly specific for pyogenic abscesses

Disadvantages

  • Expensive

  • Limited in detailing surrounding anatomic structures

  • Limited in guiding treatment

VI. What are the contraindications for the alternative imaging techniques?

CT of the abdomen and pelvis with IV contrast

  • May be contraindicated in pregnant patients

MR evaluation of the abdomen and pelvis

  • Contraindicated in patients with non-MR compatible hardware.

Ultrasound

  • No specific contraindications exist.

Nuclear medicine tagged WBC scans

  • May be contraindicated in pregnant patients

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