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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